Detection of Multiple Accessory Spleens in a Patient with Chronic Idiopathic Thrombocytopenia Purpura

Chronic idiopathic thrombocytopenia purpura is an immunologically mediated disorder resulting in disordered platelet kinetics and potentially life-threatening thrombocytopenia. Failure of medical therapy is an indication for splenectomy, and responses are seen in 70% of patients after this procedure. An important cause of relapse after splenectomy is the presence of accessory spleens. The authors describe a patient with chronic idiopathic thrombocytopenia purpura who had a relapse of symptoms 4.5 years after splenectomy. Tc-99m heat-denatured RBC planar and SPECT studies revealed the presence of multiple (more than 13) accessory spleens, but few of them were localized anatomically using computed tomography.