Ultrasonography of splenic variants

We report seven patients in whom unusual left upper quadrant abdominal masses were found on ultrasonography (US) and subsequently proven to be splenic variants. In five patients, a round discrete mass was present in the left suprarenal area, separate from a spleen which appeared to be normal. A sixth patient had multiple masses in the splenic region and a postsplenectomy seventh patient had a left posterior, para-aortic mass at the level of the renal hilum. Computed tomography (CT) confirmed the presence of the mass in four patients. In two, the mass was biopsied. Confirmatory radionuclide liver and spleen scans were performed in six patients. Single-photon emission CT proved to be most specific by demonstrating functioning splenic tissue in the region of the masses. Knowledge of the normal anatomy and embryology of the spleen readily explains the findings in our patients. Splenic variants should be considered in the differential diagnosis of problematic, left upper quadrant masses seen on US.