CASE 3. Benign Pleural Nodules in a Patient With Esophageal Cancer

A 29-year-old man was diagnosed with esophageal cancer when he presented with dysphagia. A computed tomography (CT) scan revealed multiple pleural-based soft tissue lesions in the left hemithorax, suspicious for metastases (Fig 1). His history was significant for a previous gunshot injury. A technetium-99–labeled heat-damaged autologous RBC scan demonstrated multiple foci of uptake corresponding to the CT findings, suggesting splenosis (Fig 2). A repeat CT scan 2 years later showed no interval change in the pleural masses.

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Fig 1.

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Fig 2.

Thoracic splenosis is the rare autotransplantation of splenic tissue intrathoracically following traumatic splenic injury. Functional imaging with radiolabeled RBCs is a noninvasive method of diagnosis that may be utilized instead of biopsy. The appearance on the CT images, as in this case, can be confused with metastatic tumor nodules. As the presence of pleural metastasis may affect treatment decisions in the setting of localized disease, thoracic splenosis should be considered in the differential diagnosis in patients with cancer, pleural nodules, and a history of splenic injury.

Authors' Disclosures of Potential Conflicts of Interest

The authors indicated no potential conflicts of interest.