Intrathoracic Mass Turns out to be an Accessory Spleen

Mass of spleen
Source: BMC/ Journal of Cardiothoracic Surgery

A 14 year old girl presented to the hospital on a referral that stemmed from the discovery of an abnormal mass in her left thorax. The mass had rolled in on a CT scan, taken on the account of an ATV (all-terrain vehicle) accident.

The girl denied any former injuries or hospitalizations. She did not report having any symptoms such as shortness of breath or pain in her chest. Moreover, her family history and physical examination failed to reveal any significant finding.

Another CT Scan for The Mass

Contrast enhancement on CT scan showed a 9.7 by 6.3 cm mass in her left hemi-thorax. Interestingly, it received its blood supply from inferior phrenic artery along with left internal mammary artery. Another notable thing, her lungs or chest wall did not show any abnormalities.

Following the air of a diagnostic uncertainty, doctors thought it wise to go for a complete resection. However, the did put some differentials such as malignancy and a congenital accessory spleen, on the table.

The Operation

Doctors performed a video-assisted thoracoscopic surgery (VATS). The mass was found to be in the inferomedial portion of the left thorax and was outside the pleura. They used a LigaSure device to rid it off its attachments to pleura and ligated the vessels encountered on its anteromedial surface. Good thing, they removed the entire thing and sent it to laboratory for a histological analysis.

Results Confirm an Accessory Spleen

Histological assays revealed populations of lymphocytes around the arteries, just like the spleen’s white pulp, and a stroma with sinusoids, consistent with a spleen’s red pulp. The mass had a smooth surface covered in thin translucent capsule too. A spleen right?

Post-operative Management

Doctors initially kept the girl on a chest tube which got removed on the very first day post her operation. Her post-operative period wasn’t very eventful. It didn’t have to be. Her case was more than enough to clock in some serious headlines. And just so you know, only four reports of congenital intrathoracic accessory spleen exist till date.


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