Large accessory spleen
Left loin/flank pain
CT abdomen with contrast
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Sizable left abdominal mass lesion is noted with well-defined lobulated margins, extending from the level of the tail of the pancreas to the level of the inferior pole of the left kidney. It is a retroperitoneal lesion as it stretched left renal vessels. It measures 6.7 x 6.1 x 10.1 cm in AP, SS and CC dimensions respectively. It is insinuated in between the pancreas, spleen, left kidney, stomach and bowel. It is abutting the left psoas muscle. It is of soft tissue density with heterogeneous patchy enhancement comparable to the splenic pattern of enhancement.
The mass is inseparable from the tail of pancreas. The left adrenal gland is displaced medially, separable from the lesion with no focal lesion. Right and left adrenal glands are normal. It has arterial supply from branches splenic artery.
The spleen is normal in site, size and shape with no focal lesion.
This case demonstrates a large mass lesion at the left side of the abdominal cavity with the same enhancing characteristic pattern of the spleen ("tigroid pattern"). It is also supplied by branches from the splenic artery. It is inseparable from the pancreatic tail which is also one of the sites of splenules. All these features made the diagnosis of accessory spleen the most likely possibility rather than a primary lesion.