Splenosis - mimicking peritoneal masses

Case contributed by Michael P Hartung


Abdominal discomfort. Remote history of splenectomy following trauma.

Patient Data

Age: 45 years
Gender: Male

Splenectomy. Nodule projecting inferiorly from hepatic segment 4b. Numerous small round omental and peritoneal nodules of varying sizes. Cluster with a larger nodule in the left mid-abdomen. Larger cluster in the right pelvis adjacent to bowel loops with a small calcification. 

Case Discussion

Typical appearance of splenosis in a patient with a remote history of traumatic splenic rupture and splenectomy. This can be mistaken for peritoneal carcinomatosis, particularly given the number of small omental nodules, but notice that there is no omental thickening, ascites, or diffuse peritoneal thickening/nodularity. The larger cluster in the right pelvis increases the confidence that this is splenosis.

The patient was offered a nuclear medicine study to confirm the diagnosis (heat damaged RBC or sulfur colloid) but declined. MRI with ferumoxytol is another option for confirming the benign diagnosis. 

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