Extensive abdominal splenosis: imaging features

Contrast-enhanced ultrasonographic imaging of hepatic splenosis: A case report

RATIONALE

Hepatic splenosis or heterotopic auto-transplantation of spleen in the liver usually occurs after either spleen trauma or surgery. It is of great importance for the differential diagnosis of hepatic splenosis and other liver tumors because surgery is usually not needed if a diagnosis of splenosis is confirmed.

PATIENT CONCERNS

Multiple hepatic masses were revealed by grayscale ultrasound in a 55-year-old man complaining of persistent colic in the upper abdomen after greasy food.

DIAGNOSIS

Benign neoplasm with enlarged lymph node in the gastro-hepatic ligament was suspected by contrast enhanced US. The nature of the hepatic mass was undetermined by CECT.

INTERVENTIONS

The lesions were surgically removed.

OUTCOMES

Multiple splenic tissue implants in the liver and peritoneum were confirmed by pathology after surgery. The patient recovered well and was followed up for more than 1 year without recurrence.

LESSONS

Splenosis should be included in the differential diagnosis of focal liver lesion in patients with a history of spleen trauma or surgery. In spite of nonspecific findings on pre-contrast ultrasound, splenosis shows characteristic homogeneous hyperenhancement in arterial and portal phases, as well as prolonged hyperenhancement in the late phase for more than 5 minutes. Furthermore, the confidence of the diagnosis of splenosis may be enhanced by identifying multiple masses with similar enhancing patterns in other regions of the abdominal cavity.

Splenosis mimicking pelvic mass

BACKGROUND

Splenosis is a rare complication after splenectomy and generally does not cause clinical symptoms.

CASE

A 34-year-old woman who had splenectomy in childhood after trauma presented with a pelvic mass. Ultrasound examination demonstrated a right adnexal mass and a myomatous uterus. Exploratory laparotomy revealed multiple splenic implants along the small and large bowel and in the ileocecal region, including the appendix. Total hysterectomy, right salphengectomy, and appendectomy were performed.

CONCLUSION

After splenectomy, splenic implants may mimic benign or malignant tumors of the pelvis and may require surgical exploration.