Intrapancreatic accessory spleen: CT appearance and differential diagnosis

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...

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Bibliographic Details
Published in:Abdominal imaging 2012-10, Vol.37 (5), p.812-827
Main Authors: Kawamoto, Satomi, Johnson, Pamela T., Hall, Heather, Cameron, John L., Hruban, Ralph H., Fishman, Elliot K.
Format: Article
Language:English
Subjects:
Autopsy
Biological and medical sciences
Choristoma - diagnostic imaging
Computed tomography
Contrast Media
Cysts
Diagnosis, Differential
Differential diagnosis
Erythrocytes
Gastroenterology
Gastroenterology. Liver. Pancreas. Abdomen
Hepatology
Humans
Imaging
Iron
Liver. Biliary tract. Portal circulation. Exocrine pancreas
Magnetic resonance imaging
Medical sciences
Medicine
Medicine & Public Health
Pancreas
Pancreatic Diseases - diagnostic imaging
Radiology
Scintigraphy
Spleen
Surgery
Tails
Tomography, X-Ray Computed - methods
Tumors
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Summary: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.
ISSN:2366-004X
0942-8925
2366-0058
1432-0509
DOI:10.1007/s00261-011-9830-x