Published online Dec 27, 2019. doi: 10.4254/wjh.v11.i12.773
Peer-review started: August 22, 2019
First decision: November 2, 2019
Revised: November 11, 2019
Accepted: November 25, 2019
Article in press: November 25, 2019
Published online: December 27, 2019
Splenosis is defined as the process by which tissue from the spleen disseminates through the body and grows in an ectopic location following trauma or a splenectomy. Visceral sites of splenosis are rare.
We report a case of intrahepatic splenosis in a 57-year-old man with a history of trauma over 40 years ago who initially presented with chest pain. Findings initially mimicked malignancy but a diagnosis of intrahepatic splenosis was confirmed using computed tomography and scintigraphy with technetium-99m heat-denatured red blood cells (Tc-99 DRBC).
Scintigraphy with Tc-99 DRBC is a reliable technique to diagnose splenosis and should be performed before using more invasive procedures are carried out. Splenosis should be considered as a possible differential diagnosis for a hepatic nodule in any patient with a history of abdominal trauma, previous splenectomy or atypical radiological features on imaging.
Core tip: Intrahepatic splenosis is rare. On imaging it is difficult to distinguish splenosis from hepatic malignancy, particularly hepatocellular carcinoma. We report a case of a patient with intrahepatic and intra-abdominal splenosis diagnosed using scintigraphy with technetium-99m heat-denatured red blood cells. To the author’s knowledge, this is the first case where hepatic splenosis was confirmed without using invasive procedures such as biopsy or surgery. Splenosis should be considered as an important differential for a hepatic lesion in a patient with a history of trauma or splenectomy, particularly if the lesion is located near the capsule and associated with multiple abdominal deposits.