title: Splenic infarct as a diagnostic pitfall in radiology.
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.
authors.affiliation: Department of Oncology, Palliative Care Unit, Radiology Advanced Medical and Dental Institute, Universiti Sains Malaysia, Pinang, Malaysia. scjoshi71@hotmail.com
authors.forename: Sanjeev C
authors.initials: SC
authors.lastname: Joshi
authors.forename: Ishita
authors.initials: I
authors.lastname: Pant
authors.forename: Aditya N
authors.initials: AN
authors.lastname: Shukla
authors.forename: M A
authors.initials: MA
authors.lastname: Anshari
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D000069287:Capecitabine; D002272:Carcinoembryonic Antigen / Q000097:blood; D017024:Chemotherapy, Adjuvant; D003082:Colectomy; D003110:Colonic Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004334:Drug Administration Schedule; D005472:Fluorouracil / Q000031:analogs & derivatives / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D011859:Radiography; D013154:Spleen / Q000000981:diagnostic imaging*; D013156:Splenectomy; D013159:Splenic Infarction / Q000000981:diagnostic imaging*; D013160:Splenic Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000556:secondary*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000964:Antimetabolites, Antineoplastic; D002272:Carcinoembryonic Antigen; D003841:Deoxycytidine; D000069287:Capecitabine; D005472:Fluorouracil