Splenic infarct as a diagnostic pitfall in radiology

SanjeevC Joshi, Ishita Pant, AdityaN Shukla, MA Anshari
2008 Journal of Cancer Research and Therapeutics  
free, and CEA levels were within normal limit till the fourteenth month postoperatively [ Table 1 ]. However, left abdominal pain for 1 month and raised CEA level at the fourteenth postoperative month necessitated complete metastatic workup, including X-ray chest, CECT abdomen and thorax, plain CT head, and bone scan. Computed tomography (CECT scan) [ Figure 1 ] of the thorax and abdomen revealed a rounded hypodense mass with smooth margins in the posterior one-third of the spleen; there was no
more » ... pleen; there was no dissemination of disease in the liver, peritoneum, and para-aortic lymph nodes. Based on the rising CEA levels and the radiological CECT appearance suggestive of metastatic deposits it was provisionally reported as splenic metastases. The patient was subjected to a complete preoperative workup and hematological examinations which were normal. In view of the patient's favorable Case Report ABSTRACT Follow-up of colorectal carcinoma after therapy is based on symptoms, tumor markers, and imaging studies. Clinicians sometimes face diagnostic dilemmas because of unusual presentations on the imaging modalities coupled with rising serum markers. We report a case of colorectal carcinoma that presented with gastrointestinal symptoms 14 months after completion of treatment. Investigations showed rise in carcinoembryonic antigen (CEA). Suspecting disease recurrence, complete radioimaging workup was performed; the only abnormality detected was a smooth, hypodense area in the posterior third of the spleen on contrast-enhanced computed tomography abdomen. In view of the previous diagnosis of carcinoma colon, the symptoms reported by the patient, the elevated CEA, and the atypical CECT appearance, a diagnosis of splenic metastasis was made. The patient was subjected to splenectomy as a curative treatment. However, the histopathological report revealed it to be a splenic infarct. The present case reemphasizes the limitations of radiological studies in the follow-up of carcinoma colon.
doi:10.4103/0973-1482.42262 pmid:18688130 fatcat:pwmg5sgo3bcdnfqsgehccashiu