[Splenosis simulating a renal mass]. / Esplenosis simulando una masa renal izquierda.

OBJECTIVE: To report a case of splenosis and to review its diagnosis and treatment in the related literature. METHOD: We report the case of an asymptomatic 49-year-old man with splenectomy performed when he was 22. Lumbo-sacral MRI showed a left perirenal mass probably with renal origin. RESULTS: CT scan ruled out the renal origin. Due to previous splenectomy, splenosis was suspected. 99mTc-labeled heat-damaged erythrocytes scan confirmed the diagnosis. No treatment was applied. CONCLUSIONS: Clinicians should be aware that unknown origin masses, mainly in the peritoneal cavity, with a history of previous splenic trauma or splenectomy, might represent splenosis. A non-invasive diagnosis can be achieved with 99mTc-sulphur colloid scan, 99mTc-labeled heat-damaged erythrocytes or ferrumoxide-enhanced MRI, thus avoiding unnecessary surgical explorations.

Esplenosis simulando una masa renal izquierda / Splenosis simulating a renal mass

OBJETIVO: Presentar un caso de esplenosis y revisar aspectos diagnósticos y terapéuticos en la literatura relacionada.MÉTODO: Presentamos el caso de un varón de 49 años, esplenectomizado a los 22 años. Hallazgo incidental de una masa perirrenal izquierda en RM lumbo-sacra, de probable origen renal. RESULTADOS: Se realiza TC abdómino-pélvico descartando el origen renal de la masa. Dado el antecedente de esplenectomía la sospecha diagnóstica fue de esplenosis. Se realizó gammagrafía hepato-esplénica con hematíes desnaturalizados marcados con 99mTc confirmando el diagnóstico. Se decidió abstención terapéutica.CONCLUSIONES: Ante el hallazgo de masas de origen desconocido, fundamentalmente en la cavidad peritoneal, debe ser tenida en cuenta la posibilidad diagnóstica de esplenosis, sobre todo si existe un antecedente de lesión esplénica traumática o quirúrgica. Para su diagnóstico se pueden emplear pruebas no invasivas elevada especificidad, como la gammagrafía hepato-esplénica, la gammagrafía esplénica con hematíes desnaturalizados, o la RM con ferumóxido, evitando exploraciones quirúrgicas innecesarias(AU)

Summary.- OBJECTIVE: To report a case of splenosis and to review its diagnosis and treatment in the related literature.METHOD: We report the case of an asymptomatic 49-year-old man with splenectomy performed when he was 22. Lumbo-sacral MRI showed a left perirenal mass probably with renal origin.RESULTS: CT scan ruled out the renal origin. Due to previous splenectomy, splenosis was suspected. 99mTc-labeled heat-damaged erythrocytes scan confirmed the diagnosis. No treatment was applied.CONCLUSIONS: Clinicians should be aware that unknown origin masses, mainly in the peritoneal cavity, with a history of previous splenic trauma or splenectomy, might represent splenosis. A non-invasive diagnosis can be achieved with 99mTc-sulphur colloid scan, 99mTc-labeled heat-damaged erythrocytes or ferrumoxide-enhanced MRI, thus avoiding unnecessary surgical explorations(AU)

Perineal hernia.

Abdominal wall hernias are a common abdominal pathology with higher prevalence in our population. It is usually asymptomatic but complications such as strangulation, incarceration or bowel obstruction need early detection and emergency surgery. The purpose of this article is to describe the infrequent type of hernia, illustrate the imaging findings and review the differential diagnosis. A 76-year-old woman was admitted in the emergency room with abdominal pain, vomits and diarrhoea. At her admission, a colonoscopy was attempted to perform but it was not possible to go beyond the stenosis. A barium enema and a multi-detector computed tomography (MDCT) were performed revealing a large mass in the left ischiorectal fossa, containing herniated loops of sigmoid colon adjacent to rectum. Abdominal wall hernias occur at areas of congenital or acquired weakness in the abdominal wall and are considered external hernias. MDCT is essential to identify wall hernias, make an accurate diagnosis and help for its clinical assessment. Knowing the radiological features of various types of abdominal hernias on MDCT and barium-enhanced radiographs allows confident diagnosis of these pathologies.

The spectrum of cystic masses of the pancreas: imaging features and diagnostic difficulties.

Cystic masses of the pancreas comprise a diverse group of pathologic entities ranging from pseudocysts to cystic tumors. Although their presentations may be similar, the appropriate treatment and patient management can differ greatly. There is an overlap in radiologic features, but the clinical context and some imaging findings are useful in differentiating among these entities; the differential diagnosis could be considerably reduced and it is generally possible to reach the correct diagnosis. In this article, we review imaging characteristics and radiologic patterns of both common and uncommon cystic masses of the pancreas. An algorithmic approach for the management of cystic pancreatic lesions is proposed.