CASE 10405 Published on 02.03.2013

Intrapancreatic accessory spleen causing mass: A case report and review of the literature


Abdominal imaging

Case Type

Clinical Cases


Pereira Barreiro, David 1 ; Orihuela Palomino, Amelia 1 ; Álvarez Álvarez, Carlos 2 Verdini Montemuíño, Rut Virginia 1 ; San Luis González, Ángel 1 ;
1 Servicio de Radiodiagnóstico.
2 Servicio de Anatomía patológica.

C.H. Pontevedra, SERGAS, Radiodiagnostico
doctor loureiro crespo 2
36001 Pontevedra

48 years, female

Area of Interest Abdomen, Pancreas, Spleen ; Imaging Technique CT
Clinical History
A 48-year-old woman with persistent and unspecific abdominal pain, arterial hypertension and depression. Surgical history includes left ooforectomy. Non significative analytic alteration was found.
Imaging Findings
Due to the clinical concern, a CT study was decided upon.
This contrast enhanced abdominal CT showed the presence of a well defined nodule of 1.6 centimetres. This nodule had slight enhancement in the arterial phase related to the pancreatic parenchyma with partial wash out in portal phase.
Incidentally a hiatal hernia was found.
With these findings a non-functional neuroendocrine pancreatic tumour was suspected. When the situation was explained to the patient, she felt quite anxious and chose the immediate surgical removal of the lesion before other diagnosis tests were implemented, so the patient underwent distal pancreatectomy.
Accessory spleen is defined as congenital healthy spleen's tissue separated from the main body of the spleen, and can be found in the autopsy of 10%- 30% of the population. [1] Usually they are located in the spleen's hilum, the tail of the pancreas being the second localisation [2] in order of frequency reaching 20%.
The size and shape are variable [1], from millimetres to several centimetres, and in case of splenectomy they could raise and also be a place for recurrence.
The detection of accessory spleens is especially important in those cases where all the splenic tissue of the body should be removed. Good examples of this are haematologic diseases like myeloproliferative syndromes, haemolitic anemias, and purpuras.

Usually they appear incidentally in CT, MRI or US as a well-defined nodule with an enhancement similar to the main body of the spleen in the different phases of the study.
These characteristics added to their multiple possible locations they may simulate pancreatic, gastric, intestinal or adrenal pathologies.
Surrounded by pancreatic tissue we should include in the differential diagnosis papillary epithelial neoplasm, neuroendocrinal tumours and hypervascular metastases [2, 3].

Some non-invasive techniques like MRI with RES-specific contrast or scintigraphy with Technentium-99m Heat-Damaged Red Blood Cell are able to clarify the diagnosis in these cases, so they could prevent surgery. [4]
Differential Diagnosis List
Histological examination demonstrated accessory spleen.
Papillary epithelial neoplasm
Neeuroendocrinal tumours
Hypervascular metastases
Final Diagnosis
Histological examination demonstrated accessory spleen.
Case information
DOI: 10.1594/EURORAD/CASE.10405
ISSN: 1563-4086