A 44-year-old man presents with abdominal discomfort.

Fig. 41.1 (A) Axial T2-weighted image in a young man shows a well-defined hypointense lesion in the tail of the pancreas (arrow) with signal characteristics similar to the spleen. (B) Axial T1-weighted gradient echo in-phase image in the same patient shows a well-defined hypointense lesion in the tail of the pancreas (arrow), isointense to the spleen. (C) Axial T1-weighted gradient echo out-of-phase image in the same patient shows no drop of signal in the pancreatic tail lesion (arrow). (D) Axial postcontrast fat-saturated T1-weighted image in the same patient shows the homogeneously enhancing, isointense lesion in the tail of the pancreas (arrow), isointense to the spleen.

Accessory spleen in the pancreatic tail

• Pancreatic primary neoplasm
  
• Metastases
  
• Thrombosed aneurysm
  
• Hematoma
  
• Complex pseudocyst
  
• Abscess