Intrapancreatic accessory spleen: CT appearance and differential diagnosis

The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, JHOC 3235A, 601 North Caroline Street, Baltimore, MD, 21287, USA, .
Abdominal Imaging (Impact Factor: 1.63). 12/2011; 37(5):812-27. DOI: 10.1007/s00261-011-9830-x
Source: PubMed


Although autopsy studies report that the second most common site of the accessory spleen is in the tail of the pancreas, intrapancreatic accessory spleens (IPASs) are rarely recognized radiologically. With recent improvements in imaging techniques, IPASs are more commonly detected on imaging studies. IPAS can be mistaken for other type of mass-forming lesions in the tail of the pancreas, particularly an asymptomatic small neuroendocrine neoplasm. Rarely, an epidermoid cyst originating from IPAS may simulate other cystic pancreatic lesion. Accurate preoperative diagnosis would obviate unnecessary surgery. IPAS should be considered when a hypervascular mass is seen in the tail of the pancreas on CT. Typical location, similar attenuation of the lesion to the spleen on noncontrast, and postcontrast CT at different phases are helpful to make diagnosis of IPAS. In particular, characteristic heterogeneous contrast enhancement of IPAS on the arterial phase may be helpful for correct diagnosis. However, when it remains difficult to exclude the other diagnosis, (99m)Tc labeled heat-damaged red blood cell scintigraphy or superparamagnetic iron oxide-enhanced MRI can be used to confirm the diagnosis of IPAS.

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    ABSTRACT: OBJECTIVE: The purpose of this study was to describe the prevalence and CT features of the accessory spleen. CONCLUSION: Accessory spleens are present in 16% of patients undergoing contrast-enhanced abdominal CT. Typically, accessory spleens appear on CT scans as well-marginated, round masses that are smaller than 2 cm and enhance homogeneously on contrast-enhanced images. When accessory spleens are smaller than 1 cm, their attenuation may be lower than that of the spleen because of partial volume effects. Their most frequent location (22%) is posteromedial to the spleen; anterolateral to the upper pole of the left kidney; and lateral, posterior, and superior to the tail of the pancreas. Familiarity with these characteristic features may differentiate them from other pathologic findings in the upper abdomen.
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