PMC6159283_01
Greyscale ultrasound panorama of the left hypochondrium and flank. The spleen appears as a homogeneous hypoechoic comma-shaped mass (S); it should be noted that the spleen is located under the lower pole of the kidney (K) in the ectopic position.
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On greyscale ultrasound, the spleen was not seen in the left upper quadrant; instead, there was a 19 cm long solid hypoechoic mass located under the left kidney, which was all that reminded of the spleen (Figure 1).
(a) 30 s sagittal contrast-enhanced ultrasound image showing lack of enhancement of the whole organ (asterisks), suggestive of infarction, there is absence of hilum enhancement (arrows). (b) It should be noted that no enhanced arterial or venous vessels are depicted in the splenic hilum (arrows).
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CEUS showed lack of enhancement of the whole mass and no enhancement of the vessels at the hilum (Figure 2).
Axial CT arterial phase image shows hypoattenuating left flank mass corresponding to the wandering spleen. The splenic pedicle is twisted (white arrow), giving a whirled appearance that confirms the diagnosis of torsion. The central structure of the whirl is the splenic artery with thrombus inside (black arrow), and the peripheral part corresponds to the vein with thrombus (confirmed in venous phase images, not shown).
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Axial CT imaging showed whorled appearance of a twisted splenic pedicle,which confirmed the diagnosis of torsion (Figure 3).
(a) Axial post-contrast T1 image showing the non-enhancing spleen and thin rim of enhancement of the splenic capsule located in the left lower quadrant (S). (b) Axial parasagittal T2 weighted MRI shows an ectopic spleen located under the left kidney (S). Note that the left kidney is slightly malrotated (white arrowhead).
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T1 and hyperintense T2 weighted images of the spleen without enhancement, which was consistent with infarction in the whole parenchyma (Figure 4). The splenic pedicle appeared twisted, giving it a whirled appearance, which confirmed the diagnosis.