Purpose: Accessorial spleens are often incidental findings in abdominal ultrasound. Because
of their echogenicity and behavior in contrast enhanced ultrasound they can be misjudged
as malignant tumours if found in an atypical location.
Material and methods: During routine abdominal ultrasound a small round slightly hypoechoic lesion without
halo was detected within the pancreatic tail of three persons (size 8 – 20 mm). EUS
and CEUS have been performed as well as contrast enhanced MRI, which showed a hyperenhancing
lesion without washout. Two lesions have been punctured, one lesion has been operated
(pancreatic tail resection and splenectomy).
Results: All three lesions were histologically confirmed as being accessorial spleens within
the pancreatic tail.
Conclusion: Accessorial spleen in the pancreatic tail is an important differential diagnosis
to NET tumors of the pancreas. Accessorial spleens show a moderate hyperenhancement
and washout together with the normal spleen tissue during CEUS. A histological/cytological
diagnosis by EUS puncture should be performed before operation is performed.
