Presentation
Indeterminate enhancing tail-of-pancreas lesion seen on CT angiogram.
Patient Data
Tc-99m sulfur colloid scan
Maximum intensity projection (MIP) from subsequent SPECT-CT better shows an abnormal focus of radiotracer avidity in the left upper quadrant, towards the splenic hilum, corresponding with previously seen CT abnormality.
There is an incidental focus of additional radiotracer uptake in the right lung base (just above the liver) that demonstrated no anatomic correlate and was felt to be a small benign microclot of Tc-99m sulfur colloid.
Fused SPECT-CT verifies the accumulation of sulfur colloid localizes to the indeterminate lesion in the tail of the pancreas, confirming benign intrapancreatic accessory splenule (IPAS).
Case Discussion
Intrapancreatic accessory spleens are asymptomatic lesions that are often incidentally found on imaging (as in this case) as a pancreatic tail nodule/mass and may pose a diagnostic challenge due to their nonspecific imaging findings. In such instances, a Tc-99m sulfur colloid or heat-damaged RBC scan can be used to prove the presence of splenic tissue. While heat-damaged RBC scintigraphy is considered the ‘gold standard’, the need to handle blood products and its inherent risks makes sulfur colloid the frequent first choice.
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