Perisplenic mass as initial diagnosis of malignant peritoneal mesothelioma

Abstract

Perisplenic masses or collections are rare findings on imaging examinations. The differential diagnostic spectrum is broad. We report the case of an 84-year-old man who presented to our emergency department with fatigue, unwanted weight loss, loss of appetite and abdominal pain. In B-mode ultrasound a very hypoechoic collection circularly located around the spleen was seen. A splenic hematoma or an abscess were primarily suspected. Performing contrast-enhanced ultrasound examination the perisplenic collection was surprisingly strongly contrasted in the arterial phase. An additional abdominal CT confirmed the mass in the left upper abdomen circularly around the spleen, compressing the left colic flexure and beginning to infiltrate the gastric fundus. An ultrasound-guided tissue biopsy was taken via a percutaneous intercostal approach, which resulted in the diagnosis of a low-grade epithelioid malignant peritoneal mesothelioma (MPM). MPM often presents with diffuse multifocal involvement of the peritoneal lining, however a unifocal manifestation of MPM is uncommon in general. A perisplenic mass manifestation of malignant peritoneal mesothelioma is an extremely rare occurrence. This case highlights the diagnostic challenges posed by the rare perisplenic manifestation of MPM.

Zusammenfassung

Perisplenische Läsionen oder Kollektionen sind seltene Befunde bei bildgebenden Untersuchungen. Das differenzialdiagnostische Spektrum ist breit. Wir berichten über den Fall eines 84-jährigen Mannes, der sich in unserer Notaufnahme mit Müdigkeit, ungewolltem Gewichtsverlust, Appetitlosigkeit und Bauchschmerzen vorstellte. Im B-Bild-Ultraschall zeigte sich eine stark hypoechogene, zirkulär um die Milz gelegene Kollektion. Primär wurde ein Milzhämatom oder ein Abszess vermutet. Bei der kontrastverstärkten Ultraschalluntersuchung war die perisplenische Kollektion in der arteriellen Phase überraschend stark kontrastiert. Eine zusätzliche Computertomografie bestätigte die Masse im linken Oberbauch zirkulär um die Milz, wobei sie die linke Kolonflexur komprimierte und den Magenfundus zu infiltrieren begann. Über einen perkutanen interkostalen Zugang erfolgte eine ultraschallgesteuerte Biopsie, die zur Diagnose eines niedriggradigen epithelioiden malignen peritonealen Mesothelioms (MPM) führte. Das MPM zeigt sich häufig mit diffusem, multifokalem Befall des Peritoneums, eine unifokale Manifestation des MPM ist jedoch im Allgemeinen selten. Eine perisplenische Manifestation eines MPM ist extrem selten. Dieser Fall verdeutlicht die diagnostischen Herausforderungen, die die seltene perisplenische Manifestation des MPM mit sich bringt.

Keywords

perisplenic - CEUS - mesothelioma - biopsy - peritoneal

Schlüsselwörter

perisplenisch - CEUS - Mesotheliom - Biopsie - peritoneal

Publikationsverlauf

Eingereicht: 17. März 2025

Angenommen nach Revision: 26. Mai 2025

Artikel online veröffentlicht:
24. Juni 2025

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