A rare case of accessory spleen torsion in a child diagnosed by ultrasound (US) and contrast-enhanced ultrasound (CEUS)

Abstract

Introduction Accessory spleen, also known as supernumerary spleen or splenunculum, is a congenital anomaly of the spleen due to a fusion defect during the embryogenesis. Usually it is detected casually during an ultrasound (US) examination of the abdomen and it is asymptomatic. Case report: results We present a case of a 12 years old male patient, with 2-days history of left abdominal pain, without fever, gastrointestinal or genitourinary symptoms. The day before our observation, the patient had gone to another hospital, from where he had been discharged with medical analgesic therapy, without any benefit. Blood tests were normal, the Ultrasound abdominal examination showed normal aspect of abdominal organs, but the presence in the left side of a small round parenchymal structure surrounded by hyperechogenic mesenteric fat. We interpreted this image as an accessory spleen, complicated by torsion. As the torsion of accessory spleen is a quite rare occurrence, we carried out a contrast enhanced ultrasound (CEUS) to get more information. CEUS showed the absence of enhancement of the nodular formation, suggestive for a complete lack of vascularization; the spleen was normally enhanced. While the management in case of accessory spleen torsion is non-operative, in this case the patient underwent surgical exploration, due to the persistence of abdominal pain despite the medical therapy, with clinical signs of peritoneal reaction, mimicking an acute abdomen. Surgery confirmed the diagnosis of accessory spleen torsion. Discussion and conclusions In conclusion, US is the first diagnostic tool in pediatric abdominal pain and allows to direct the diagnosis; the use of CEUS helps to clarify the US reports, without leaving doubts about the parenchymal vascularization of the abdominal organ involved.

Contrast-Enhanced Ultrasound (CEUS) in Non-Traumatic Abdominal Emergencies

“…The same CEUS semeiotics can be seen in testicular or ovarian torsion and infarction, torsion of the spermatic cord and epididymis, as described in the study by Badea et al ( Fig. 5 6 ) 12 38 39 40 41 . An advantage of CEUS in the pediatric population is the lack of radiation exposure.…”

Torsion of an Accessory Spleen in a Child With Biliary Atresia Splenic Malformation Syndrome

“…Complications, such as torsion and infarction, are extremely rare. To the authors knowledge, only 19 pediatric cases of accessory splenic torsion, including the current case, have been described in the English literature (2)(3)(4)(5)(6)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). This is the second reported case of an accessory splenic torsion occurring in a child with known situs inversus and the only documented case in a patient with BASM (5).…”

“…Maintaining a high index of suspicion, especially in a patient with known splenic anomalies, is paramount as results of diagnostic imaging may be nonspecific or unavailable in the emergency setting. As seen in Figures 1, 2, CT appearance of an accessory splenic torsion may mimic a drainable abdominal fluid collection or abscess (8). Ultrasonography with Doppler and magnetic resonance imaging may allow for further characterization of a possible torted splenule, however even with modern imaging modalities the diagnosis is often uncertain.…”

Tumor pélvico: bazo accesorio

“…El BA, llamado también supernumerario o esplenúnculo o esplénulo, es una entidad poco frecuente, cuyo origen es congénito y se produce por la falta de fusión de los esbozos esplénicos, lo que explicaría la presencia del bazo en su localización habitual al mismo tiempo que tejido esplénico de localización ectópica. 2,5 La prevalencia del BA mediante estudios de imagen es de 16,6%, pero varía: en Oceanía es de 26,6%, en Norteamérica es de 16,7%, y en Asia de 14,1%. 6 En nuestro país no hay estudios al respecto.…”