Case of the Month: July 2013, Page 2

Answer: E (Old Granulomatous disease and Accessory spleen)

Explanation

For full-size image, click CT Abdomen 2 .



Axial contrast CT demonstrates a small spherical accessory spleen (white arrow) near the splenic hilum. Note the foci of calcifications from histoplasmosis near the main and accessory spleen.  These findings are so characteristic no additional work up is needed.

Discussion

Accessory spleens, also known as supernumerary spleens, splenunculi, or splenules, are congenital foci of healthy splenic tissue that are separate from the main body of the spleen.  These are usually round in appearance and 1 to 4 cm in size.   Characteristic features that help distinguish an accessory spleen from a malignant mass is they have the same density, texture and enhancement pattern as the spleen.  As in our example, they are usually located adjacent to the splenic hilum.  Another similar and confusing term that is commonly used is splenosis.  Splenosis is distinct from the term splenules in that it refers to residual splenic tissue that has implanted anywhere including abdomen, pelvis, and chest from prior trauma and is not congenital.

Question # 2

What is a imaging exam that may be used to differentiate an accessory spleen from a neoplastic mass?

A- PET
B- US
C- T-cm Sulfur colloid or heat damaged RBC scan
D- All of the above


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