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Which is the most likely etiology of a spherical mass near the splenic hilum that is isoechoic to the normal spleen in a 55-year-old female?
Suggested Answer: B
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An accessory spleen (splenule) is a congenital variant, commonly located near the splenic hilum, and has identical echogenicity to the native spleen. This finding is benign and often incidental.
According to Rumack's Diagnostic Ultrasound:
''Accessory spleens are typically found near the splenic hilum and are isoechoic to the normal splenic parenchyma.''
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
AIUM Practice Parameter for Abdominal Ultrasound, 2020.
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30 comments · newest first
HA
Han
6 months ago
Accessory spleen is the most likely. Less invasive to consider.
DE
Desirae
6 months ago
I lean towards lymph node too. Need more imaging.
FL
Flo
6 months ago
True, but the isoechoic nature points to accessory spleen.
CA
Carissa
6 months ago
But what about a lymph node? Could be enlarged.
FA
Farrah
7 months ago
I agree, accessory spleen makes sense. It's common.
CE
Cecilia
7 months ago
I agree, accessory spleen seems most likely!
GL
Glenna
7 months ago
Wait, how can a pancreatic mass be isoechoic? Sounds off.
CA
Candida
8 months ago
Isn't it weird how it can look just like the normal spleen?
AV
Avery
8 months ago
I thought it could be a lymph node, though.
EL
Elly
8 months ago
Definitely leaning towards accessory spleen here.
JO
Jonelle
8 months ago
Lymph node? What is this, a game of Where's Waldo? Come on, people.
EL
Elli
8 months ago
Accessory spleen, no doubt. I can already picture the ultrasound image in my mind.
AN
Annmarie
8 months ago
Kidney mass? Really? I don't think that's the most likely option here.
JO
Johnathon
9 months ago
Hmm, a pancreatic mass near the spleen? That's an interesting one. I'll have to remember that.
YU
Yun
9 months ago
Definitely an accessory spleen! I've seen those before in my clinical rotations.
CH
Chun
9 months ago
This question feels familiar; I think we had a case study on splenic masses, and accessory spleen was the answer there too.
IZ
Izetta
9 months ago
I think the isoechoic nature suggests it could be an accessory spleen, but I also recall a practice question about lymph nodes that looked similar.
LA
Laurel
9 months ago
I remember discussing accessory spleens in class, but I'm not entirely sure how to differentiate them from lymph nodes.
DA
Danica
9 months ago
This is the kind of question I feel prepared for. The combination of the radiographic findings and patient demographics makes me confident that an accessory spleen is the most probable explanation.
LU
Luis
10 months ago
I'm a bit unsure about this one. The location and imaging features don't immediately point me to one clear answer. I'll have to review my notes on differential diagnoses for splenic masses.
AR
Arminda
10 months ago
I think it's probably an accessory spleen. Looks similar.
ST
Stanford
10 months ago
I’m leaning towards lymph node, but I feel like I need to double-check the ultrasound characteristics of pancreatic masses.
JO
Jonell
10 months ago
Hmm, I'm a little stuck on this one. I know we covered splenic masses in class, but I'm having trouble recalling the key distinguishing features. Time to quickly review my study guide.
AR
Arthur
11 months ago
Okay, let's think this through step-by-step. An isoechoic mass near the spleen in a middle-aged female... Accessory spleen seems like the most likely option here.
YU
Yuette
11 months ago
Hmm, this seems like a tricky one. I'll need to carefully consider the key details - the location, the imaging characteristics, and the patient's age and gender.
HA
Harrison
5 months ago
True, but we shouldn't rule out other options just yet.
LA
Lang
5 months ago
Lymph nodes can be tricky, but the age fits for an accessory spleen.
BE
Belen
6 months ago
But what about the lymph node?
ST
Stephaine
6 months ago
That makes sense, especially with the isoechoic nature.
AL
Albina
10 months ago
I think it could be an accessory spleen.