A 32-year-old man presented with 3 weeks of fever, a tender abdominal mass and lymphocytosis. He had undergone splenectomy following abdominal trauma 22 years earlier. A computed tomography (CT) scan revealed a soft tissue mass in the left abdomen (Fig. 1,upper panels, three views), which was identified by a Tc-99m labelled heat-damaged red blood cell scan (with single-photon emission CT (SPECT)) as an enlarged ectopic spleen (Fig. 1, middle panel: SPECT, lower panel: CT + SPECT fused, three views). The patient's serology for cytomegalovirus (CMV) returned positive for IgM and negative for IgG antibodies, consistent with acute CMV infection. Two weeks later the patient was asymptomatic, and the 'abdominal mass' was no longer palpable. Thus, acute CMV mononucleosis had induced a transient tender splenomegaly in an ectopic spleen, presenting as a tender abdominal mass.
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