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Society for Pediatric Radiology – Poster Archive
Final ID: Poster #: CR-007 (S)
Abdominal Pain of Rare Origin
Purpose or Case Report: Introduction: Accessory spleen is an abnormality represented by ectopic splenic tissue detached from the main body of the spleen. Torsion is a possible complication and it occurs exceptionally. Clinically it is characterized by a nonspecific acute or recurrent abdominal pain.
Case: A 12 years old female with recurrent abdominal pain and palpable mass on her left iliac fossa, that has been noticed a month before consultation. At the emergency service she was checked and complementary exams were requested.
US: In the left iliac fossa it was found a solid, rounded formation, with well-defined edges, which moved when the patient changed her position. It showed positive Doppler examination except for a focal hypoechogenic area, which was not vascularized. The structure reminded the spleen echogenicity.
CT: normal spleen parenchyma, shape and edges. At left iliac fossa, next to the lower pole of the kidney, a rounded well-defined image which showed heterogeneous EV enhancement with no opacification of the lower corner due to ischemia areas was seen. This image had a vascular hilum that connected to the main spleen vascular hilum. Further images where taken changing the patient position, where the movement of the mass was corroborated.
As a result of this exams we realized that the recurrent abdominal pain of the girl was due to an ectopic spleen that has been torsioned - detorsioned several times.
Conclusions: Usually, accessory spleen is asymptomatic. Torsion and infarction, rupture with bleeding, and infection with abscess are a very rare complications. Intermittent torsion-detorsion may produce recurrent episodes of abdominal pain caused by short-lasting ischemia of the accessory spleen or from direct mechanical irritation of surrounding organs.
To sum up, torsion of an accessory spleen is extremely rare and is still a diagnostic dilemma. So we should consider this any time a patient with abdominal pain (acute or recurrent) comes to us and other diagnosis failed to explain it.
Methods & Materials:
Results:
Conclusions:
Case: A 12 years old female with recurrent abdominal pain and palpable mass on her left iliac fossa, that has been noticed a month before consultation. At the emergency service she was checked and complementary exams were requested.
US: In the left iliac fossa it was found a solid, rounded formation, with well-defined edges, which moved when the patient changed her position. It showed positive Doppler examination except for a focal hypoechogenic area, which was not vascularized. The structure reminded the spleen echogenicity.
CT: normal spleen parenchyma, shape and edges. At left iliac fossa, next to the lower pole of the kidney, a rounded well-defined image which showed heterogeneous EV enhancement with no opacification of the lower corner due to ischemia areas was seen. This image had a vascular hilum that connected to the main spleen vascular hilum. Further images where taken changing the patient position, where the movement of the mass was corroborated.
As a result of this exams we realized that the recurrent abdominal pain of the girl was due to an ectopic spleen that has been torsioned - detorsioned several times.
Conclusions: Usually, accessory spleen is asymptomatic. Torsion and infarction, rupture with bleeding, and infection with abscess are a very rare complications. Intermittent torsion-detorsion may produce recurrent episodes of abdominal pain caused by short-lasting ischemia of the accessory spleen or from direct mechanical irritation of surrounding organs.
To sum up, torsion of an accessory spleen is extremely rare and is still a diagnostic dilemma. So we should consider this any time a patient with abdominal pain (acute or recurrent) comes to us and other diagnosis failed to explain it.
Methods & Materials:
Results:
Conclusions:
More abstracts on this topic:
Fatty Falciform Ligament Appendage Torsion: Diagnosis and Management in a Pediatric Patient.
Horak Richard, Mega James, Tanton Phillip, Criman Erik, Tabak Benjamin, Rooks Veronica
Imaging Features of Adnexal TorsionCielma Tara, Adeyiga Adebunmi, Bandarkar Anjum
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Poster____CR-007_(S).pdf
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