Diagnosis of gastric subepithelial mass as an accessory spleen using fusion of spleen SPECT and CT images

Abstract

More than 10% of the healthy population has one or more accessory spleens. An accessory spleen can be mistaken for a gastric subepithelial mass, and may not be differentiated by CT or endoscopic ultrasonography (EUS). A gastric subepithelial mass was detected on routine endoscopy in a 52-year-old man with a history of splenectomy 10 years previously for trauma. Subsequent EUS and CT located the subepithelial mass on the fourth layer of the stomach fundus. A definitive diagnosis was obtained by performing technetium-99m (99mTc-)-labeled denatured red blood cell (RBC) scintigraphy. Fusion images were obtained by combining the digital CT and SPECT images on a computer workstation. Here, we report the use of spleen SPECT and CT fusion images to diagnose a case of accessory spleen mimicking a gastric subepithelial mass, thereby avoiding the need for an invasive procedure.

Accessory Spleen: A Rare and Incidental Finding in the Stomach Wall

“…On EUS, the accessory spleen is rounded, and its echogenicity is identical to that of the spleen [ 4 ]. Technetium 99 m-sulfur colloid scintigraphy is a sensitive and specific imaging modality to detect splenic tissue and may assist in diagnosing an accessory spleen [ 7 - 9 ]. Given our patient's previous history of splenectomy, it was impossible to compare the accessory spleen's parenchyma to her spleen.…”

Accessory spleen misdiagnosed as left adrenal tumor causing complications

“…The accessory spleen is a congenital ectopic spleen tissue share similar structures and functions to normal with an incidence of 10%-30% [1]. It can occur anywhere in the abdominal cavity, usually in the splenic hilum or the tail of the pancreas [2,3].…”