Accessory spleen torsion: US, CT and MR findings

Abstract

Torsion of an accessory spleen is a very unusual entity that can appear with abdominal pain associated with the presence of an avascular mass. We report the case of a 13-year-old boy with torsion and infarction of an accessory spleen presenting as a painful abdominal mass in which imaging examination with US, CT and MR showed a large avascular mass in the upper left abdomen.

Enlarged accessory spleen presenting stomach submucosal tumor

“…Based on these findings, an accessory spleen was suspected. Some accessory spleens, however, can mimic an enlarged lymph node as well as a tumor arising from adjacent organs such as the adrenal gland, pancreas and kidney [14][15][16][17] . In fact, differentiation from a hypervascular pancreatic neoplasm (e.g.…”

“…Although an accessory spleen is an incidental finding with no clinical significance in most patients [3,6] , the detection and characterization would be occasionally important in the clinical scenarios [11][12][13][14][15][16][17] . Accessory spleens may become symptomatic because of torsion, spontaneous rapture, hemorrhage and cystic formation [14][15][16][17] .…”

“…A diagnosis of accessory spleen manifesting as a gastric SMT was made. As complications associated with an accessory spleen can rarely include torsion of a wandering accessory spleen or bleeding caused by spontaneous rupture [14][15][16][17], the patient is now carefully followed in outpatient clinic.…”

“…It is located at the splenic hilum or adjacent to the pancreatic tail in most cases [3,6] . Although it is usually asymptomatic and incidentally discovered, accessory spleen is clinically important in certain patients [7][8][9][10][11][12][13][14][15][16][17] . It is likely that some accessory spleens simulate tumors arising from adjacent organs such as the kidney, adrenal grand and pancreas [3][4][5][6][7][8][9][10] .…”

Torsion of a splenule

“…Failed fusion of mesenchymal splenic buds results in splenules in the left side of the abdomen, usually in the splenic hilum (75%) [1,2]. Torsion of a splenule is rare and imaging is usually inconclusive but an early US exam can prove the diagnosis, showing identical echo to the spleen and absence of blood flow before necrosis develops.…”