Abdomen / Pelvis for Monday, June 1st, 2026

Contributed by Amsterdam University Medical Center (AUMC).
Evita van Amerongen, and Rick van Rijn.

History

A 16-year-old male adolescent with an unremarkable medical history was referred by his general practitioner to the radiology department for lumbar spine radiography due to chronic low back pain. The symptoms had been present for approximately 4–5 months and showed no improvement despite conservative treatment with physiotherapy.

Images (Click any image to enlarge)

PA Lumbosacral Spine X-ray. No significant osseous pathology. Incidental finding: just superior to the left iliac crest, within the retroperitoneum (as shown on the lateral radiograph), a well-circumscribed spherical lesion with subtle wall calcifications measuring approximately 6.1 × 5.5 cm. Ultrasound was performed.
Lateral Lumbosacral Spine X-ray
Abdominal ultrasonography demonstrated a well-defined, encapsulated heterogeneous mass with mixed solid and cystic components, measuring 5.1 × 4.4 × 4.6 cm. A dubious doppler-flow signal was detected.
Longitudal axis ultrasound through mass. The mass seems to originate from the pancreatic tail (claw-sign).
Transversal axis ultrasound through mass.

Question

What is the most likely diagnosis?

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