Thoracic Splenosis - A necessary differential diagnosis for pleural based nodules with history of thoracoabdominal trauma

Thoracic Splenosis (TS) is a rare medical condition, where there is auto-transplantation of the splenic tissue in the thoracic cavity, often leading to pleural based nodules. Our patient is the first ever case of this condition in Pakistan, and underwent extensive diagnostic procedures as well as medical treatments, before receiving the diagnosis of TS. He underwent HRCT for chronic cough that revealed pleural and mediastinal nodules. This coupled with a vague mass in the testes led to the provisional diagnosis of metastasized testicular tumour, and later a diagnosis of pulmonary tuberculosis was made. However, eventually a (99m)Tc denatured red blood cell scan confirmed the diagnosis of TS. TS is a benign condition, whereas other causes of pleural nodules are relatively malignant, hence its diagnosis is essential in ruling out malignancies. Among the multiple invasive and non-invasive diagnostic modalities, the gold standard remains (99m)Tc denatured red blood cell scan, which is a sensitive test that provides an accurate diagnosis and bars the need of multiple invasive procedures.