Findings :
* Evidence of gunshot fragments at the left retroperitoneal space and posterior abdomiunal wall.
* Status post splenectomy, with multiple soft tissue masses ( arrows ) scattered in the peritoneum adjacent to the gall bladder, posterior to right lobe of liver, in the left upper abdomen near the bowel loops and adjacent to the left posterior abdominal wall
Impression :
Such features of multiple scattered intra-abdominal soft tissue masses , along with the history of previous splenectomy, are highly suggestive of splenosis .. for further evaluation by 99 mTc heat-damaged RBCscan.
Diagnosis :
Splenosis
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Splenosis: is an acquired condition defined as autotransplantation of viable splenic tissue throughout different anatomic compartments of the body ( mainly the peritoneum, mesentery and omentum ), occurs after traumatic or iatrogenic rupture of the spleen with its blood supply is derived from the surrounding tissues and vessels.
The splenic origin of these nodules can be confirmed radiologically by combining the results of CT and a liver spleenscan. 99 mTc sulphur colloid can be used to show the splenic nodules. However, 99 mTc heat-damaged RBC is a more sensitive test because of a lower uptake by liver tissue, resulting in a higher target to background
ratio.