Case of the Month: July 2013, Page 3

Answer: C (T-cm Sulfur colloid or heat damaged RBC scan)

Explanation

For a full-size image, please click CT Abdomen 3 .



Functional uptake in Technetium sulfur colloid or heat-damaged red cell scan helps differentiate from other masses although it is not a specific test.   Anterior and posterior images of the chest and abdomen obtained 30 minutes after injection of Tc-99m in vitro-labeled heat-damaged red blood cells in a different patient that is status post splenectomy. Two foci of increased activity are seen in the posterior aspect of the left upper quadrant consistent with residual splenic tissue on both the planar and SPECT images.  

The findings of splenules on a PET scan can be confusing especially when looking for metastatic disease in a patient with known cancer.   Spenules will be FDG avid and may mimic tumor.  

For a full-size image, please click CT Abdomen 4 .



An axial image from a PET scan shows two foci of FDG avidity (arrows) that could be mistaken for metastatic foci, but correspond to the two splenules, or accessory spleens, that are shown on the CECT.

Discussion

Although spenules are a relatively common benign finding there are a couple of scenarios where the detection and characterization of an accessory spleen is important. First, an accessory spleen may mimic lymphadenopathy and tumors in other abdominal organs, such as the pancreas, the adrenal gland, and the kidney. Second, accessory spleens occasionally may become symptomatic because of torsion, spontaneous rupture, hemorrhage, and cyst formation. Third, a surgeon's awareness of their presence may be important when the intention is to remove all functional splenic tissue.


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