Extraparenchymal opacities at thoracic imaging: Clues to an unusual etiology

Nick Sparacino, Allen Thomas, Jasminder W. Mand, Michael Gotway, Jeffrey L. Sparacino

Research output: Contribution to journalArticle

Abstract

Abnormal opacities detected at chest radiography must be localized as parenchymal or extraparenchymal to facilitate differential diagnosis. Extraparenchymal opacities may arise from the chest wall soft tissues, osseous structures, or pleura. Regarding the latter, pleural effusion and fibrothorax are commonly recognized patterns of pleural disease encountered at thoracic imaging. Less commonly, nodules or masses arising from the pleura may be seen, and usually this imaging pattern reflects the presence of pleural malignancy. However, there are rare conditions that may affect the pleura and simulate malignant pleural disease, particularly thoracic splenosis. Splenosis represents autotransplantation of functional splenic tissue into ectopic sites, most frequently within the abdomen, and rarely the thorax. Splenosis usually results from episodes of thoracoabdominal trauma or following splenectomy, and may reach the left thorax, implanting on the left-sided pleura, when diaphragmatic injury is also present. Thoracic splenosis is most often detected asymptomatically by imaging performed for incidental reasons. The condition typically presents with left-sided pleural nodules or masses, which may enhance profoundly following intravenous contrast administration at thoracic CT, thereby simulating malignant pleural disease. If imaging manifestations or historical evidence of previous thoracic trauma are found, the diagnosis may be suspected, but often such is lacking as the enticing event has long been forgotten by the patient. Therefore, a high index of suspicion for thoracic splenosis must be maintained when left-sided pleural lesions suggesting pleural malignancy are encountered. The diagnosis of thoracic splenosis may be confirmed noninvasively with nuclear medicine techniques.

Original languageEnglish (US)
Pages (from-to)151-153
Number of pages3
JournalClinical Pulmonary Medicine
Volume22
Issue number3
DOIs
StatePublished - May 15 2015

Fingerprint

Splenosis
Thorax
Pleura
Pleural Diseases
Wounds and Injuries
Choristoma
Autologous Transplantation
Nuclear Medicine
Thoracic Wall
Splenectomy
Pleural Effusion
Radiography
Intravenous Administration
Abdomen
Neoplasms
Differential Diagnosis

Keywords

  • ectopic tissue
  • pleural nodule
  • splenosis
  • Trauma

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Extraparenchymal opacities at thoracic imaging : Clues to an unusual etiology. / Sparacino, Nick; Thomas, Allen; Mand, Jasminder W.; Gotway, Michael; Sparacino, Jeffrey L.

In: Clinical Pulmonary Medicine, Vol. 22, No. 3, 15.05.2015, p. 151-153.

Research output: Contribution to journalArticle

Sparacino, Nick ; Thomas, Allen ; Mand, Jasminder W. ; Gotway, Michael ; Sparacino, Jeffrey L. / Extraparenchymal opacities at thoracic imaging : Clues to an unusual etiology. In: Clinical Pulmonary Medicine. 2015 ; Vol. 22, No. 3. pp. 151-153.
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