Huge accessory spleen with torsion, mimicking splenic lymphangioma: A case report and review of the literature.

Abstract

Approximately 30% of population can have an accessory spleen, which is most often asymptomatic. Only when it becomes large in size, it may elicit symptoms, mostly due to complications, such as torsion, infarction, or traumatic hemorrhage. The preoperative diagnosis of an accessory spleen is often challenging due to its propensity to manifest the neoplasms of adjacent organs. Here we report a rare case of a huge tortured accessory spleen mimicking splenic lymphangioma and to review the literature. A 27-year-old man was admitted to the emergency department following left hypochondrial pain that lasted for three days. The computed tomography scan findings demonstrate the spleen in its normal position, showing smooth outlines attached to a similar-density cystic heterogenous mass exhibiting strong radiological evidence of splenic lymphangioma. Surgical excision was performed, and a large tortured accessory spleen was discovered that was attached to the lower pole of the spleen by connective tissue. An accessory spleen is always smaller than 4cm, and accessory spleens larger than that, especially with torsion, are extremely uncommon. According to literature, the identification of accessory spleen on the basis of clinical and radiological features is very difficult, especially when the patient presents with symptoms of acute abdomen. Considering the fact that accessory splenic tissue can mimics neoplasms of the spleen or nearby organs, it should be included in the differential diagnosis in an undiagnosed pre- or intraoperative hypochondrial mass, located in the vicinity of the spleen.