Correct!
4. SPECT/CT scan (single photon emission computed tomography/computed tomography) with 99 m technetium-labelled sulphur

The homogenous nature of the mass, along with a  history of splenectomy following severe trauma to the abdomen, raises suspicion for a rare pleural pathology, intrathoracic splenosis or pleural splenosis (3,4). Although PET scan is useful investigating pleural malignancies, technetium 99 scintigraphic studies- with demonstration of ectopic intrathoracic sulfur colloid uptake- are gold standard for diagnosis of pleural splenosis. Such uptake would indicate hematopoiesis. Our patient’s SPECT/CT is shown in Figure 5.

Figure 5. Patient’s SPECT/CT scan (single photon emission computed tomography/computed tomography) with 99 m technetium-labelled sulphur.

What is the best next step? (Click on the correct answer to be directed to the seventh and final page)

  1. Interval CT scan follow up every 6 months
  2. Interval NM SPECT follow up every 6 months
  3. Pleural biopsy to confirm the diagnosis
  4. Reassurance and clinical follow up
  5. Surgical resection of pleural masses

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