Wandering accessory spleen

Case contributed by Dr Doaa Khedr Mohamed Khedr

Presentation

Chronic left hypochondrial pain four months ago.

Patient Data

Age: 40 years
Gender: Female
CT

Triphasic CT abdomen revealed a well-defined homogeneously enhancing oval-shaped soft tissue seen in the left hypochondrial region, measuring 4.3x5.3 x5.2 cm (AP xTr X CC respectively).

The pre-contrast study shows fine foci of calcification. After IV contrast, it shows homogenous enhancement similar to spleen with tigroid appearance

It is seen as separable from inflated descending colon loops and indenting-related jejunal loops.

On MIP images, the feeding artery is seen arising from the splenic artery and the veins drain into the splenic vein.

Case Discussion

Wandering accessory spleen is a challenging radiological diagnosis. It has several differential diagnoses including; GIST, lymphoma, and peritoneal metastasis 1.

This case shows a left hypochondrial mass with a vascular pedicle connected to the splenic vessels (Jokari sign) 2.

Complications include; hemorrhage, spontaneous rupture, and torsion 3.

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