Splenic infarct as a diagnostic pitfall in radiology

Area of Science:

• Oncology
• Radiology
• Gastroenterology

Background:

• Post-treatment surveillance for colorectal carcinoma typically relies on symptom assessment, tumor markers, and imaging.
• Diagnostic challenges arise from atypical imaging findings and rising serum markers, potentially indicating recurrence.

Observation:

• A patient with a history of colorectal carcinoma presented with gastrointestinal symptoms 14 months post-treatment, accompanied by elevated carcinoembryonic antigen (CEA).
• Contrast-enhanced computed tomography (CECT) revealed a hypodense splenic lesion, raising suspicion for metastasis.
• The patient underwent splenectomy for presumed splenic metastasis.

Findings:

• Histopathological examination of the spleen revealed a splenic infarct, not metastatic colorectal carcinoma.
• This case underscores the potential for misinterpretation of imaging findings in the follow-up of colorectal cancer.

Implications:

• The study highlights the limitations of radiological modalities in definitively diagnosing metastatic disease in the spleen during colorectal cancer surveillance.
• It emphasizes the importance of integrating clinical presentation, tumor markers, and histopathology for accurate diagnosis and management.