Copyright Article author (or theiremployer) 2016. Produced byBMJ Publishing Group Ltd (&BTS) under licence. 3 2 1 cetd1 uy2016 July 18 Accepted 2016 June 22 Received heartofengland.nhs.uk maninder.kalkat@ UK; 5SS, B9 Birmingham East, Green Bordesley Hospital, Heartlands Birmingham Kalkat, S Maninder to Correspondence UK Birmingham, Hospital, Heartlands Birmingham Histopathology, UK Birmingham, Hospital, UK Birmingham, Hospital, Heartlands Birmingham Surgery, eatetof Department City Radiology, of Department Thoracic of Department thoraxjnl-2016-209068 doi:10.1136/ Year] Month [ First: Thorax NA, Kaushal NE, Drury cite: To laeinclude please ulse Online Published Thorax OnlineFirst,publishedonSeptember5,2016as10.1136/thoraxjnl-2016-209068 etlaM, Remtulla Day tal et . te hnalprtm scar. laparotomy a TB than unremarkable with other was contact examination denied Physical asbestos. and or non-smoker hemidiaphragm. a left He was the injury. He of repair splenic and laparotomy, and splenectomy emergency an hemithorax stomach undergone had the left therefore of the herniation hemi- into with left injury pneumothoraces, diaphragm bilateral sustained he hnara traf road a than ugcancer advanced lung as masquerading splenosis Thoracic THORAX IN IMAGES ntelwrlf eihrx()ado irsoy o oe iwo h xie ein hwdval oue of nodules viable showed lesions excised (B). the pulps of white view and power red low demonstrating microscopy, tissue on splenic and encapsulated (A) normal hemithorax histologically left lower the in 2 Figure (B). hemithorax left the in nodules pleural tissue soft 1 Figure of previously history been had a He with cough. presented in man 38-year-old A Kalkat S Maninder Remtulla, Mohammedabbas fl ez-iesmtm n essetdry persistent a and symptoms uenza-like etlaM, Remtulla utpeperlndlswr on uigvdoasse hrcsoi ugr uruddb adhesions by surrounded surgery thoracoscopic video-assisted during found were nodules pleural Multiple multiple demonstrating CT and (A) silhouette cardiac the behind mass large a showing radiograph Chest fi olso 0yasao nwhich in ago, years 20 collision c tal et 1 . Thorax 2016; fi 0:1 n el other well, and t 1 ie Drury, E Nigel – .doi:10.1136/thoraxjnl-2016-209068 2. 1 h ada ihutessiiu o rmr lung primary for ( suspicious cancer silhouette cardiac the ypaeoah eese.Tesle was to spleen posterior noted were The nodules mediastinal further seen. but or absent were lesions pulmonary lymphadenopathy mm; 21 right-sided to up no measuring hemithorax, in left nodules lower pleural-based the other multiple were There a ocrigfrlclivso ( invasion which local plane, fat for clear no concerning aspect with posterior was ventricle the left to the related of closely lobe, lower con ai Kaushal, A Nazia hs aigahsoe ag pct behind opacity large a showed radiograph Chest fi mda4 msf isems nteleft the in mass tissue soft mm 41 a rmed fi ue1 gure ) To h hrxadabdomen and thorax the of CT A). 2 io Trotter, E Simon hs clinic Chest fi ue1 gure

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on September 25, 2021 by guest. Protected by copyright. by Protected guest. by 2021 25, September on Chest clinic Chest clinic soitdwt ruai iprgai utr aebeen have splenosis rupture thoracic periton- diaphragmatic of the traumatic cases reported. of few seeding with commonly mesentery; with associated most pelvis, or is or omentum into It abdomen eum, develop the tissue. and in supply splenic found blood differentiated local of a nodules onto derive implant inci- surface, fragments high serosal splenic relatively a Ectopic the trauma. splenic despite of rare, dence is splenectomy, or rupture neakbeval pei ise con ( tissue, splenosis excised splenic were dia- viable which surface, unremarkable of lung several the pleura, ( on mediastinal scattered brown, and dark seen the phragm numerous During were of lung, lesions division the diagnosis. rounded after of adhesions; mobilisation histological and dense pleural adhesions by a lower obliterated the was (VATS), establish space surgery to thoracoscopic video-assisted nodules the tail. atic ipy fssetd h igoi a lob aeby made be also may diagnosis VATS the or suspected, needle with If investigation biopsy. invasive malig- prompting intrathoracic an nancy, for symptoms. mistaken causes be rarely may and nodules Pleural-based trauma splenic after decades several h etkde,ajcn otesplenic the to adjacent kidney, left the 2 fi hs clinic Chest ue2 gure peoi,teattaslnaino pei isefollowing tissue splenic of autotransplantation the Splenosis, h utdsilnr emrcmeddbos foeof one of biopsy recommended team multidisciplinary The hrccslnssuulypeet sa incidental an as presents usually splenosis Thoracic ) itlg hwdndlso ogse u largely but congested of nodules showed Histology A). 1 fi ue2 gure ) hr a omalignancy. no was there B); fl fi xr n ttepancre- the at and exure mn h igoi of diagnosis the rming fi nding onl T rne M erCA, Kerr AM, Brunner NT, Connell 3 ai F atnM,PtlR, Patel MR, Martin UF, Malik 2 estvt n speci and sensitivity high a has which scan, 99m-Technetium erythrocyte heat-damaged eoehsoyo hrcadmnltam,epcal nthe rupture. diaphragmatic in and especially injury splenic trauma, known of thoracoabdominal a setting and of nodules history pleural left remote asymptomatic with presenting prophylactic patient early and immunisation for remains. and penicillin need infection, the post-splenectomy therefore, overwhelming insuf is against function function tection and immune volume reduced residual with the associated as still normal is resembles it histology tissue, the splenic while However, excision. peutic omn P iu ,Dmn M, Dumont M, Rioux JP, Normand 1 REFERENCES review peer and Provenance consent Patient interests Competing manuscript. the composing Contributors ncnlso,toai peoi hudb osdrdi a in considered be should splenosis thoracic conclusion, In thera- require not does and condition benign a is Splenosis rvdspo protection. poor provides mgn ihu naiepoeue a rvd diagnosis. provide may procedures invasive without imaging rqec n imaging and frequency etlaM, Remtulla l uhr eeivle ntemngmn fteptetand patient the of management the in involved were authors All Obtained. tal et 3 oedeclared. None fi . fi iyfrslnctissue. splenic for city ndings. Thorax Virulence tal et o omsind xenlype reviewed. peer externally commissioned; Not mJRoentgenol J Am 2016; aecya hrccslnss itr n nuclear and history splenosis: thoracic Parenchymal . tal et tal et 2011;2:4 0 peoi n ess h onaanspleen born-again the sepsis: and Splenosis . hrccslnssatrbuttrauma: blunt after splenosis Thoracic . :1 – .doi:10.1136/thoraxjnl-2016-209068 2. – 11. 1993;161:739 2 fi lnMdRes Med Clin J in ocne pro- confer to cient – 41. 2010;2:180

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Thorax: first published as 10.1136/thoraxjnl-2016-209068 on 5 September 2016. Downloaded from from Downloaded 2016. September 5 on 10.1136/thoraxjnl-2016-209068 as published first Thorax: http://thorax.bmj.com/ on September 25, 2021 by guest. Protected by copyright. by Protected guest. by 2021 25, September on