Poster 194 Resolution of Thoracic Back Pain in Collegiate Runner after Ultrasound‐Guided Costotransverse Joint Injection: A Case Report

Disclosures: R. Nguyen, No Disclosures: I Have No Relevant Financial Relationships to Disclose. Case Description: The patient is a 45-year-old woman who presented with chronic right groin pain that started about 10 years prior. Because she was an avid dancer, she attributed her pain to years of dancing. She saw Orthopaedics and underwent hip and pelvis x-rays which demonstrated preserved joint spaces. She underwent an MR arthrogram of the right hip which showed evidence of fluid accumulating in the right greater trochanteric bursa. There was no evidence of labral tear, occult bony abnormality, muscle tear, or psoas tenosynovitis. She had been through PT, used ice, and NSAIDs. Of note, she had a motor vehicle accident 26 years prior with subsequent spleen rupture and then was diagnosed with ectopic spleen and underwent surgical removal by OB/GYN one year prior. Program Description: Musculoskeletal outpatient center. Setting: Academic Center. Results or Clinical Course: MRI pelvis was obtained showing increased signal overlying the right greater trochanter suggesting trochanter bursitis and gluteal tendinopathy. There was a 5 2 cm intrapelvic globular lesion on the left side of the pelvis and a 2.5 2 cm lesion on the right side of the pelvis. There were other bilateral lower pelvis soft tissue lesions, possibly external iliac adenopathy. She underwent a spleen nuclear scan, which confirmed ectopic spleen. It was felt that the masses were likely the underlying etiology of her pain given the local compression and traction on nearby structures. She saw General Surgery. CT was obtained showing absent spleen and multiple enhancing soft tissue masses, including in the omentum and right pelvic sidewall likely representing splenosis. She was planned for surgical excision with GYN-Oncology and Vascular Surgery given the close proximity to the vascular structures. Discussion: We present an interesting case of splenosis resulting in groin/pelvic pain manifesting many years later. While there have been descriptions of splenosis in the gynecologic and internal medicine literature, this is a unique case in an athlete who first underwent orthopaedic evaluation as symptoms initially suggested hip pathology. Conclusions: When the past medical history includes posttraumatic splenectomy and other workup is unrevealing, symptomatic splenosis should be considered in the differential diagnosis of chronic groin/pelvic pain.