Accessory Spleens Near Adrenal Glands: Diagnostic Challenges Unveiled

In a rare medical occurrence, a 33-year-old male patient in Syria presented with right hypochondrium pain, previously having undergone a splenectomy due to a childhood accident. The patient’s symptoms included sharp pain radiating to the right flank, worsened by movement and large meals. Upon admission, his vital signs were stable, with abdominal tenderness in the right upper quadrant. Laboratory tests showed normal values, prompting further imaging studies.

Ultrasound revealed a lobulated mass near the right adrenal gland, while a multi-slice computed tomography (MSCT) scan showed multiple nodules in the right adrenal gland, with lymphadenopathy around the abdominal aorta. Elevated metanephrine levels raised concerns of an extra-adrenal pheochromocytoma. Subsequent laparoscopic surgery revealed three accessory spleens and normal adrenal tissue, dispelling suspicions of malignancy.

The spleen, a vital organ in the lymphatic system, plays a crucial role in immune function. Various congenital and acquired abnormalities can affect the spleen, including wandering spleen, accessory spleen, and polysplenia syndrome. An accessory spleen, often benign and asymptomatic, can be mistaken for tumors, especially when located in unusual sites like the adrenal glands. Accurate diagnosis of accessory spleens typically requires nuclear medicine imaging or fine needle aspiration.

In this case, the presence of three accessory spleens near the adrenal glands posed a diagnostic challenge, ultimately resolved through surgical intervention. Such cases underscore the importance of considering accessory spleens in differential diagnoses for masses near the adrenal glands. While most accessory spleens are harmless, their occurrence in atypical locations can complicate diagnosis and management, necessitating further research to enhance understanding and treatment strategies.

The intricate nature of embryonic spleen development and the prevalence of accessory spleens in the population highlight the need for healthcare providers to remain vigilant in evaluating masses near vital organs. With advancements in diagnostic imaging and surgical techniques, cases like the one reported here can be effectively managed, emphasizing the importance of comprehensive care and accurate differential diagnoses in complex medical scenarios.