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Accessory Spleen And Splenules

  • “ In addition to conventional morphologic MR imaging, DW (diffusion weighted) imaging can be used as a tool for differentiating intrapancreatic accessory spleen (IPAS) from solid pancreatic tumors.”
    Differentiation of an Intrapancreatic Accessory Spleen from a Small (<3-cm) Solid Pancreatic Tumor: Value of Diffusion-weighted MR Imaging
    Jang KM et al
    Radiology 2013; 268:159-167
  • “The diagnosis and differentiation of intrapancreatic accessory spleen from a solid pancreatic tumor by using visual assessment of similarity between pancreatic lesions and spleen on diffusion weighted images yields high diagnostic accuracy (90-95%), sensitivity (95-100%), specificity (86-91%), positive predictive value (86-91%) and negative predictive value (95-100%).”
    Differentiation of an Intrapancreatic Accessory Spleen from a Small (<3-cm) Solid Pancreatic Tumor: Value of Diffusion-weighted MR Imaging
    Jang KM et al
    Radiology 2013; 268:159-167
  • Intrapancreatic Accessory Spleen: CT Findings
    CT attenuation and enhancement pattern
    - Similar enhancement on noncontrast and postcontrast scans
    - Arterial phase enhancement is similar to the spleen including the serpiginous pattern of enhancement
  • Intrapancreatic Accessory Spleen: Differential Dx
    - Neuroendocrine tumor (NETs)
    - Metastatic renal cell carcinoma to the pancreas
    - Splenic artery aneurysm
  • “ However, when it remains difficult to exclude the other diagnosis, 99m-Tc labeled HDRBC scintigraphy or SPIO-enhanced MR imaging can be used to confirm the diagnosis of IPAS, with the caveats described above.”
    Intrapancreatic accessory spleen: CT appearance and differential diagnosis
    Kawamoto S, Johnson PT, Hull H, Cameron JL, Hruban RH, Fishman EK
    Abdom Imaging (2012)37:812-827
  • “After traumatic splenic injury or splenectomy, small isolated spleens may develop. These implants are not limited to the left upper quadrant, and splenosis in other locations can mimic other pathologic entities. This pictorial essay presents the range of appearances of intraabdominal and pelvic splenosis.”
    CT of splenosis: patterns and pitfalls.
    Lake ST, Johnson PT, Kawamoto S, Hruban RH, Fishman EK.
    AJR 2012 Dec;199(6)W686-93
  • "Typically, accessory spleens appear on CT scans as well marginated, round masses that are smaller than 2 cm and enhance homogeneously on contrast-enhanced images. When accessory spleens are smaller than 1 cm, their attenuation may be lower than that of the spleen because of partial volume effects."

    CT Features of the Accessory Spleen
    Mortele KJ et al.

  • "Typically, accessory spleens appear on CT scans as well marginated, round masses that are smaller than 2 cm and enhance homogeneously on contrast-enhanced images."

    CT Features of the Accessory Spleen
    Mortele KJ et al.
    AJR 2004; 183:1653-1657
  • Accessory Spleen: Facts

    "Differentiation from a hypervascular pancreatic neoplasm (e.g. islet cell tumor) is, therefore sometimes challenging."

    CT Features of the Accessory Spleen
    Mortele KJ et al.
  • Accessory Spleen: Facts
    - Present in 16% of patients undergoing contrast enhanced CT
    - Usually 2 cm or less in size
    - Usually enhance equal to the normal spleen but lesions under 1 cm may not
    - May simulate pancreatic, renal or adrenal pathology