Imaging‑based diagnosis of intrapancreatic accessory spleen: A case report

Kovačević,Karla; Puškarić,Biljana Jelić; Kovačević,Dragica Obad

doi:10.3892/br.2024.1801

Imaging‑based diagnosis of intrapancreatic accessory spleen: A case report

Authors:
- Karla Kovačević
- Biljana Jelić Puškarić
- Dragica Obad Kovačević
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Affiliations: Department of Diabetes and Endocrinology, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, 10 000 Zagreb, Croatia, Department of Pathology and Cytology, Merkur University Hospital, 10 000 Zagreb, Croatia, Department of Diagnostic and Interventional Radiology, Merkur University Hospital, 10 000 Zagreb, Croatia
Published online on: June 12, 2024 https://doi.org/10.3892/br.2024.1801
Article Number: 114
Copyright: © Kovačević et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

During a routine ultrasound examination of the abdomen, a 60‑year‑old male patient was diagnosed with mass in the tail of the pancreas. However, computed tomography (CT) suggested that the lesion was an intrapancreatic accessory spleen (IPAS). IPAS is a congenital anomaly, which usually does not present with symptoms. IPAS occurs during embryologic splenic development when a portion of the splenic tissue fails to fuse with the main body of the spleen. IPAS does not require treatment, except when it is combined with idiopathic thrombocytopenic purpura. In the present case, the diagnosis of IPAS was confirmed using magnetic resonance imaging (MRI). On CT and MRI, the IPAS had a density and intensity comparable with that of the spleen in all plain and contrast‑enhanced phases. Due to comorbidities, the patient refused further evaluation or surgery. The lesion was periodically monitored using CT every 1‑2 years. Since the tumour was stable during the 7‑year follow‑up, it was concluded that it was an IPAS. In patients that cannot undergo surgery, a characteristic location (near the spleen) and imaging features (such as a ‘zebra‑patterned’ enhancement in the arterial phase on CT and high signal intensity on diffusion‑weighted imaging sequences on MRI, which is comparative to that of the normal spleen) may allow for a diagnose of IPAS with a high level of certainty. Being aware of this condition could aid a correct diagnosis of IPAS and prevent unnecessary surgery.

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