58-year-old female with left flank pain

Submitted by Colin Burke, MD, Kambrie Kato, MD, and Bernard Chow, MD while at Santa Barbara Cottage Hospital, Santa Barbara, CA.

A 58-year-old female with a medical history significant for asthma, diabetes and hypertension presented to the emergency department with left flank pain of 1 day’s duration. She also reported a 100.8ºF fever but denied nausea or vomiting. On physical exam, she was afebrile with an occasional cough, 4/10 pain, and mild abdominal tenderness to palpation in the left upper quadrant. There was no CVA tenderness or peritoneal signs. She denied any trauma. Her white blood cell count was slightly elevated (12,500) with an increased neutrophil count (10,000/ul). Due to the patient’s continued pain, a contrast-enhanced CT of the abdomen and pelvis was obtained.

 

 

 

Contiguous axial CT images of the abdomen and pelvis were obtained using non-ionic contrast material, and coronal and sagittal reformats were also provided. These images revealed a hypoattenuating, round, soft-tissue mass inferior and anterior to the spleen with mild inflammatory changes of the surrounding mesenteric fat (Figure 1). On coronal and sagittal reformats, there was also a curvilinear structure extending superiorly from the mass which could be traced back to the splenic artery, likely representing a splenic arterial branch (Figures 2A, 2B).  This mass had been seen on a chest PE with contrast study 12 years prior and had similar contrast enhancement patterns and Hounsfield unit values as the spleen, compatible with a splenule (Figures 3A, 3B).

Splenules are often mistaken for what neoplasm?

Lymphoma
Islet cell pancreatic cancers
Metastatic disease
Melanoma


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