Endoscopic Ultrasound

IMAGES AND VIDEOS
Year
: 2019  |  Volume : 8  |  Issue : 4  |  Page : 281--282

Differentiating intrapancreatic accessory spleen from a pancreatic neuroendocrine tumor or metastasis by the “bridge sign”


Manoop S Bhutani1, Ben S Singh1, Irina M Cazacu2, Adrian Saftoiu3,  
1 Department of Gastroenterology, Hepatology and Nutrition-Unit 1466, UT MD Anderson Cancer Center, Houston, Texas, USA
2 Department of Gastroenterology, Hepatology and Nutrition-Unit 1466, UT MD Anderson Cancer Center, Houston, Texas, USA; Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Craiova, Romania
3 Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Craiova, Romania

Correspondence Address:
Dr. Manoop S Bhutani
Department of Gastroenterology, Hepatology and Nutrition-Unit 1466, UT MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, Texas 77030-4009
USA




How to cite this article:
Bhutani MS, Singh BS, Cazacu IM, Saftoiu A. Differentiating intrapancreatic accessory spleen from a pancreatic neuroendocrine tumor or metastasis by the “bridge sign”.Endosc Ultrasound 2019;8:281-282


How to cite this URL:
Bhutani MS, Singh BS, Cazacu IM, Saftoiu A. Differentiating intrapancreatic accessory spleen from a pancreatic neuroendocrine tumor or metastasis by the “bridge sign”. Endosc Ultrasound [serial online] 2019 [cited 2019 Nov 18 ];8:281-282
Available from: http://www.eusjournal.com/text.asp?2019/8/4/281/260856


Full Text



An accessory spleen (splenule) may be present in 10%–30% of the general population.[1] Majority of these are located around the splenic hilum with a smaller number within the pancreatic tail.[2] The intrapancreatic accessory spleens not infrequently cause diagnostic confusion (especially with neuroendocrine tumors of the pancreas or pancreatic metastases) on imaging modalities such as CT, MR, and US. Even fine-needle aspiration or surgery has been done for patients with intrapancreatic accessory spleens due to continued concern for a pancreatic neoplasm. [Figure 1] shows an intrapancreatic accessory spleen during EUS where a round, homogeneous, well-defined lesion is seen in the pancreas tail that may be indistinguishable from a neuroendocrine tumor or a metastatic lesion. However, on dynamic real-time EUS imaging with careful transducer movement, the lesion is seen to be connected to the spleen with a bridge of splenic tissue. The authors would like to name it “the bridge sign” [Figure 2]. Nothing else is needed at this point. This simple technique saves the patient an EUS-FNA, diagnostic confusion, surgery, anxiety, and health-care dollars. Let's not forget this dynamic EUS imaging aspect before reaching for the biopsy needle!{Figure 1}{Figure 2}

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Halpert B, Alden ZA. accessory spleens in or at the tail of the pancreas. A survey of 2,700 additional necropsies. Arch Pathol 1964;77:652-4.
2Chan KJ, Fenton-Lee D. Intrapancreatic accessory spleen masquerading as a pancreatic neuroendocrine tumor. J Gastrointest Surg 2018;22:1799-800.