Indian Journal of Nuclear Medicine

INTERESTING IMAGE
Year
: 2018  |  Volume : 33  |  Issue : 2  |  Page : 180--181

Decisive Role of Nuclear Imaging in a Rare Pancreatic Incidentaloma


Madhusudhanan Jegadeesan1, Chidambaram Natrajan Balasubramanian Harisankar2, Thippa Sivaraman Nivetha3, Thippa Sivaraman Swetha3, Mariappan Murugan4, Alwin Gunaraj1, Alwar Ramanujam1,  
1 Department of Gastroenterology and Liver Transplantation, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India
2 Department of Nuclear Medicine, Meenakshi Mission Hospital and Research Centre, Madurai, Tamil Nadu, India
3 Department of Gastroenterology, Velammal Medical College, Madurai, Tamil Nadu, India
4 Department of Radiology, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India

Correspondence Address:
Dr. Madhusudhanan Jegadeesan
Department of Gastroenterology and Liver Transplantation, Velammal Medical College Hospital and Research Institute, Madurai - 625 009, Tamil Nadu
India

Abstract

Pancreatic incidentalomas are increasingly recognized entities that occur as a fallout of widespread availability of high definition imaging technology. These lesions offer diagnostic dilemmas to both clinicians and radiologists alike. Nevertheless, it is the advancement in diagnostic radiology that comes to the rescue in the management of these not-so-uncommon lesions.



How to cite this article:
Jegadeesan M, Balasubramanian Harisankar CN, Nivetha TS, Swetha TS, Murugan M, Gunaraj A, Ramanujam A. Decisive Role of Nuclear Imaging in a Rare Pancreatic Incidentaloma.Indian J Nucl Med 2018;33:180-181


How to cite this URL:
Jegadeesan M, Balasubramanian Harisankar CN, Nivetha TS, Swetha TS, Murugan M, Gunaraj A, Ramanujam A. Decisive Role of Nuclear Imaging in a Rare Pancreatic Incidentaloma. Indian J Nucl Med [serial online] 2018 [cited 2020 Mar 31 ];33:180-181
Available from: http://www.ijnm.in/text.asp?2018/33/2/180/227491


Full Text



A 33-year-old male presented with severe upper abdominal pain for the past 6 months with on/off nausea and vomiting. Magnetic resonance (MR) cholangiopancreatography showed stones in the cystic duct and neck of gallbladder with features suggestive of chronic cholecystitis. Incidentally, a small well-defined T2-weighted hyperintense lesion of size 1.6 cm × 1.5 cm was seen at the tail of pancreas, and the lesion showed restricted diffusion. An interesting finding was noted by our clinicians, that the intrapancreatic lesion was strikingly similar in intensity to spleen in all the phases of MR imaging (MRI) [Figure 1]. Following this, we performed a nuclear imaging study with technetium-labeled sulfur colloid. Static planar images and hybrid single-photon emission computed tomography images of the abdomen were acquired which showed physiological tracer uptake in the liver and spleen. A focus of sulfur colloid uptake was also noted in the tail of pancreas which corresponded to the previously described lesion noted on MRI [Figure 2]. These findings confirmed the diagnosis of intrapancreatic location of accessory spleen. The patient underwent an uneventful laparoscopic cholecystectomy during which laparoscopic mobilization of the tail of pancreas was done [Figure 3]. The lesion was appearing similar to spleen necessitating no further intervention for the pancreatic incidentaloma.{Figure 1}{Figure 2}{Figure 3}

Intrapancreatic splenunculus is rarely symptomatic and does not require any treatment. Its diagnosis is difficult if unsuspected.[1],[2] Embryologically, it arises from the failure of fusion of splenic anlage located in the dorsal mesogastrium during the 5th week of fetal life.[3] Diligent attention to subtle radiological clues and an understanding of embryological/anatomical concepts will help in timely diagnosis. This ultimately serves to avoid unnecessary surgeries thereby avoiding major complications. Furthermore, we would like to state that, even though the definite investigation for identification of ectopic splenic tissue is heat denatured red blood cell (RBC) scintigraphy,[4] sulfur colloid scintigraphy appears to be a reasonable, and practical alternative as infrastructure for heat denaturation of RBC is not widely available in all nuclear medicine departments.[5],[6]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

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