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Intrapancreatic Splenule

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0:01

So during the embryonic age,

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the spleen and the pancreas both develop

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from the dorsal mesogastrium.

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It is a kind of primitive mesentery,

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which starts from gastrohepatic ligament,

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encases the stomach, and then contains the bud

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of the spleen as well as the pancreas.

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So both of the organs actually move from the

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dorsal mesogastrium to the retroperitoneum.

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And it's possible during this, this

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migration, some of the tissue of the spleen

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can be retained during the, this passage

0:31

or the pathway in the retroperitoneum,

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and can be anywhere in between the cords.

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But most of the time,

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the abnormal location of the spleen

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tissue is in the pancreatic tail.

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And that is seen as intrasplenic,

0:45

intrapancreatic spleenules on imaging.

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And they can mimic some of the masses, and they

0:51

can be misinterpreted as the cancer sometimes.

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So this is a case here, where we are trying to

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characterize a lesion in the pancreatic tail.

1:01

And as we come here, we see a well-

1:04

defined lesion in the pancreatic tail.

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Which is very well circumscribed,

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well-defined, and looking almost like

1:12

a spleen on T2-weighted sequences.

1:16

And if we compare this intensity with the

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pancreas, see this is the intensity of the

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pancreas with lobulation and the fat inside,

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see the intensity here versus the intensity of this

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lesion, which just mimics the spleen altogether.

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And otherwise, we do not see any

1:32

other lesion in the pancreas.

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The pancreatic duct is not dilated.

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And CVD is slightly prominent, but that can be

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physiological because the gallbladder is missing.

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And if we compare this lesion on other

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intensities, other sequences, for example,

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out of phase image here, we see the spleen tissue

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and the tissue in the pancreatic tail,

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which we have seen on the previous images in this

2:03

region, difficult to perceive on these images.

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If we go to T1-weighted

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fat-suppressed images,

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we see this lesion here in the pancreatic

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tail looking different than the rest of

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the parenchyma on pre-contrast images.

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See, the rest of the parenchyma is T1 slightly

2:21

hyperintense, but that looks slightly

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different than the rest of the parenchyma.

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And if we look for fat-suppressed T2-weighted

2:30

images here, the same kind of appearance is here.

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The lesion is well-circumscribed and

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mimics the spleen but looks slightly

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different than the rest of the parenchyma.

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And if we go to the post-contrast images

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and see the enhancement pattern of this lesion,

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so this is more enhancing than the rest of

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the parenchyma, enhancing slightly more

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than the parenchyma of the

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pancreas, almost mimicking the spleen.

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And the same thing happening here,

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following the spleen.

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So while a circumscribed lesion mostly in

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the distal pancreas or the tail,

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which follows the splenic parenchyma in all of the

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sequences, whether it is pre-contrast or post-

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contrast, is diagnostic of intraparenchymal

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pancreatic splenules which can mimic a mass, as in this case.

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You can confidently call it splenules if that

3:28

follows splenule in all those sequences.

Report

Faculty

Neeraj Lalwani, MD, FSAR, DABR

Professor and Chief of Abdominal Radiology

Montefiore Medical Center, New York

Tags

Pancreas

Oncologic Imaging

Gastrointestinal (GI)

Body

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