Intrahepatic and widely distributed intraabdominal splenosis: multidetector CT, US and scintigraphic findings

Splenosis is the autotransplantation of splenic tissue that usually follows traumatic rupture of the spleen or splenectomy [1]. Once considered rare with only 51 cases reported until 1973 [2], splenosis is much more common, occurring in up to 75% of all patients undergoing splenectomy for traumatic injury [3]. Hyperplastic splenic residues following splenectomy or traumatic rupture of the spleen may result in incidentally discovered masses which require a differential diagnosis from other disorders including neoplastic diseases. We report a rare case of splenosis involving liver and both intra and extraperitoneal spaces, discussing radiological methods and haematological features for a correct diagnosis. A 41-year-old man who had undergone splenectomy at the age of six for spleen rupture due to a car accident came to our attention because of a suspected urinary stone disease. We performed abdominal ultrasonography (US) which showed multiple solid masses located in the splenic bed, in the hepatic interlobar fissure, in the seventh segment of the liver and in the Morrison pouch close to the upper pole of the right kidney as additional findings. All nodules had a smooth round or ovoid shape, ranging from 0.5 to 4.5 cm diameter, with a homogeneous echotexture and a hyperechoic peripheral rim. The lesions revealed no specific arterial or venous Doppler signals. Chemical and haematological exams, including cell blood count and tumor markers were normal. Chronic hepatitis B and C were excluded. Peripheral blood smears showed normal leukocyte and erythrocyte morphologies. Furthermore, there was no evidence of Howell–Jolly bodies, suggesting the persistence of splenic function.