Woman 63 yo, pain at left subcostal for one month without fever.
Abdomen ultrasound detected the spleen changing its surface, irregular lobular border with many hypoechoic structures intraspleen from hilus and free fluid around the spleen ( see us 1, us 2).
MSCT with CE found out inhomogeneous structure of spleen, with many hypodense zones, non enhancement with contrast from hilus of spleen radiated toward peripheric zones of spleen, and tail of pancreas was adherent to spleen hilus.
Radiologist suggested tumor of the tail of pancreas invasive to hilus of spleen ( see ct 1, 2, 3).
Blood tests were normal all cancer markers, and blood amylase highly elevated.
Preoperative diagnosis the case was vascular thrombosis of spleen due to inflammation of the pancreatic tail.
Operation for splenectomy, and removing the hilus mass of spleen ( see macro).
Microscopic report was chronic necrosis due to inflammation.
Discussion: Clinical with pain for more one month at left upper adominal area whch was KEHR' s sign.
Ultrasound detected many avascular zones in spleen.
MSCT with CE find out wedge – shape.
Blood test : high amylase, looked like PANCREATITIS at the tail complicated to hilus of SLPEEN INFARCTION.
REF case report from JOP.