Presentation
Incidental soft tissue nodule in anterior abdomen identified on CT urogram for hematuria. Remote history of splenectomy following motor vehicle accident.
Patient Data
CT urogram demonstrates an absence of the normal spleen in the left upper quadrant, consistent with a history of a prior splenectomy due to trauma. An abnormal round soft tissue nodule is present in the anterior midline abdomen.
Given the history and appearance, the patient was referred to nuclear medicine for Tc-99m sulfur colloid scintigraphy.
Liver-spleen scan was performed using Tc-99m sulfur colloid IV.
Planar images show normal homogeneous uptake throughout the liver and faint marrow activity. The spleen is absent, consistent with the history of splenectomy following trauma. In the low pelvis, there is a faint focus of radiotracer accumulation in the region of the soft tissue nodule seen on CT (a high contrast, high-intensity anterior view is provided).
Maximum intensity projection (MIP) from subsequent SPECT-CT better demonstrates the abnormality.
Fused SPECT-CT verifies the accumulation of sulfur colloid localizes to the indeterminate nodule, confirming benign splenosis.
Case Discussion
Abdominal splenosis is seen after abdominal trauma or splenectomy. It is due to seeding of small deposit of splenic tissue in the peritoneal cavity along serosal and peritoneal surfaces. When the diagnosis is unclear, as in this case, a Tc-99m sulfur colloid or heat-damaged RBC scan can be used to prove the presence of splenic tissue. While heat-damaged RBC scintigraphy is considered the ‘gold standard’, the need to handle blood products and its inherent risks makes sulfur colloid the frequent first choice.
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