Combined Intrathoracic and Subcutaneous Splenosis Discovered 51 Years after Abdominal Trauma.

Splenosis is a rare condition that results from the autotransplantation of splenic parenchyma into unexpected locations such as the abdomen or subcutaneous tissue. In the presence of coexisting injury to the diaphragm intrathoracic transplantation can occur emerging as single or multiple pleural-based masses. This occurs after traumatic rupture of the spleen and is usually asymptomatic, only to be discovered incidentally on routine thoracic or abdominal imaging. To our knowledge this is the third documented case of combined intrathoracic and subcutaneous splenosis found in English literature. This occurred in a 71-year-old male involved in a motor vehicle accident at age 19 requiring urgent splenectomy. He has a significant cigarette smoking history and was referred to our hospital for further evaluation of an abnormality seen on shoulder X-ray.

Hiding in plain sight; constrictive pericarditis.

We present a case of constrictive pericarditis that was especially difficult to diagnose. The patient presented with generalised oedema, dyspnoea and pleural effusions. History was significant for prior polysubstance abuse but was otherwise unremarkable. Physical examination revealed only jugular venous distention. CT demonstrated a normal pericardium with pleural effusions. Echocardiography showed mildly elevated right ventricular pressures with dyssynergic motion of the ventricular septum. No intervention was being carried out, but 1 month later further evaluation with a right and left heart catheterisation showed the classical square-root sign with equalisation of diastolic pressures in both ventricles as well as ventricular interdependence. Idiopathic constrictive pericarditis was thus diagnosed with a subsequent pericardial stripping which confirmed a thickened pericardium encasing the heart.

Unusual cause of shortness of breath after surgery for thoracic outlet syndrome.

A 31-year-old postal worker was diagnosed with bilateral thoracic outlet syndrome and scheduled for the first of two surgeries. The first procedure involved removal of the right first cervical rib, anterior and middle scalenes. On postoperative day 4, he developed shortness of breath. Chest radiograph showed a new pleural effusion on the right. Thoracentesis revealed a yellowish-red thick effusion. Based on the initial look of the fluid it was thought to be a haemorrhagic effusion with a purulent component, further testing revealed that he had developed a chylothorax. The patient was placed on a medium-chain triglyceride diet followed by chest tube drainage. After one day, the chest tube was removed due to minimal drainage, and he was discharged home the next day. Keeping this patient without food, on total parental nutrition, or pursuing surgical intervention was not necessary, as he had an excellent outcome from a very rare surgical complication.