Splenosis is one type of ectopic splenic tissue (the other being accessory spleen). It is an acquired condition and is defined as autoimplantation one or more focal deposits of splenic tissue in various compartments of the body.
Abdominal splenosis is seen after abdominal trauma or surgery (e.g. splenectomy). They result from seeding of the peritoneal cavity with splenic tissue which recruits local blood supply. They are typically small, sessile (as they grow on serosal/peritoneal surfaces) and multiple. They may grow overtime to become quite sizeable. If located only intrahepatically, they can cause serious diagnostic problems.
Similar process occurring in the thorax is called thoracic splenosis. It is rare and presents as multiple pleural based nodules in the left hemithorax. It typically occurs following blunt trauma causing a combination of splenic injury and left diaphragmatic rupture4.
They are benign, their greatest importance being the need to distinguish them from more sinister pathology.
They typically rounded or sessile nodules, and have density and enhancing characteristics similar to the rest of the spleen or expected density of the spleen if there has been a splenectomy.
Signal characteristics are similar to normal spleen 2
- T1: hypo intense
- T2: hyper intense
- T1 C+ (Gd): heterogenous enhancment
Tc 99m sulphur colloid scan
The diagnosis can be confirmed with Tc99m sulphur colloid scan which will demonstrate increased uptake as long as the splenunculus is at least 2 cm in diameter; improved sensitivity with hybrid imaging (SPECT/CT) is possible 7.
When Tc99m sulphur colloid fails to prove splenic tissue, Tc99m-tagged heat-damaged RBC scan (Tc-99m-DRBC) with autologous erythrocytes remains gold-standard of imaging, being capable of specifically proving splenic tissue 6,8.
Splenosis should not be confused with polysplenia or accessory spleens (splenunculi), which are congenital in origin and retain arterial supply from the splenic artery. They are also composed of normal splenic tissue. Depending on their location they may appear to be arising from various organs, and thus mimic malignancy.
The differential diagnosis for soft tissue nodules include
- 1. Mortelé KJ, Mortelé B, Silverman SG. CT features of the accessory spleen. AJR Am J Roentgenol. 2004;183 (6): 1653-7. AJR Am J Roentgenol (full text) - Pubmed citation
- 2. Lin WC, Lee RC, Chiang JH et-al. MR features of abdominal splenosis. AJR Am J Roentgenol. 2003;180 (2): 493-6. AJR Am J Roentgenol (full text) - Pubmed citation
- 3. Brancatelli G, Vilgrain V, Zappa M et-al. Case 80: splenosis. Radiology. 2005;234 (3): 728-32. doi:10.1148/radiol.2343030695 - Pubmed citation
- 4. Naylor MF, Karstaedt N, Finck SJ et-al. Noninvasive methods of diagnosing thoracic splenosis. Ann. Thorac. Surg. 1999;68 (1): 243-4. Ann. Thorac. Surg. (full text) - Pubmed citation
- 5. Thourani VH, Sharma J, Duarte IG et-al. Intrathoracic splenosis. Ann. Thorac. Surg. 2005;80 (5): 1934-6. doi:10.1016/j.athoracsur.2004.06.121 - Pubmed citation
- 6. Menth M, Herrmann K, Haug A et-al. Intra-hepatic splenosis as an unexpected cause of a focal liver lesion in a patient with hepatitis C and liver cirrhosis: a case report. Cases J. 2009;2 (1): 8335. doi:10.4076/1757-1626-2-8335 - Free text at pubmed - Pubmed citation
- 7. Mazurek A, Szaluś N, Stembrowicz-Nowakowska Z et-al. Detection of splenic tissue by 99mTc-labelled Sn-colloid SPECT/CT scintigraphy. Nucl Med Rev Cent East Eur. 2012;14 (2): 116-7. Pubmed citation
- 8. Ehrlich CP, Papanicolaou N, Treves S et-al. Splenic scintigraphy using Tc-99m-labeled heat-denatured red blood cells in pediatric patients: concise communication. J. Nucl. Med. 1982;23 (3): 209-13. Pubmed citation
- normal appearance of the spleen
- pseudolesion of the spleen: inhomogeneous splenic enhancement
splenic lesions and anomalies
- congenital anomalies
- mass lesions
- infiltrative processes
- incidental splenic lesion (approach)