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Tail of pancreas

The tail of the pancreas is the narrow, tapering end of the gland that extends toward the splenic hilum. It is the only portion of the pancreas that often lies within the splenorenal ligament and may reach the hilum of the spleen. Unlike the head and neck, the tail is more mobile and closely associated with the spleen, left kidney, and splenic vessels.

The tail is clinically important because it contains a relatively high concentration of islets of Langerhans and is a common site for endocrine tumors. It is also surgically relevant during distal pancreatectomy and splenectomy.

Synonyms

  • Pancreatic tail

  • Distal pancreas

Location and Relations

  • Anteriorly: Posterior wall of stomach and peritoneum of the lesser sac

  • Posteriorly: Left kidney and adrenal gland

  • Superiorly: Splenic artery (running along upper pancreatic border)

  • Inferiorly: Splenic vein (coursing beneath tail toward portal vein)

  • Laterally: Hilum of the spleen

  • Medially: Pancreatic body

Function

  • Contains numerous islets of Langerhans, important in endocrine regulation (insulin, glucagon, somatostatin)

  • Contributes to exocrine function by secreting digestive enzymes into the pancreatic duct

  • Maintains relationship with spleen and splenic vessels, important in splenic and pancreatic circulation

Clinical Significance

  • Pancreatic carcinoma: Tail tumors often remain silent until late due to absence of bile duct obstruction

  • Pancreatic neuroendocrine tumors (pNETs): Commonly arise in the tail due to high islet density

  • Trauma: Vulnerable to injury in splenic trauma

  • Surgical relevance: Often removed in distal pancreatectomy with or without splenectomy

  • Cysts & pseudocysts: May develop in chronic pancreatitis, often extending to spleen or left kidney

  • Imaging relevance: Tail masses must be distinguished from splenic hilar lesions

MRI Appearance

T1-weighted images:

  • Normal tail: intermediate signal intensity, slightly higher than liver

  • Fat planes around splenic hilum: bright signal

  • Tumors: hypointense focal lesions

T2-weighted images:

  • Normal parenchyma: relatively low-to-intermediate signal

  • Pancreatic duct: bright tubular line traversing the tail

  • Cysts/pseudocysts: very bright signal

  • Tumors: mildly hyperintense compared to parenchyma

STIR (Short Tau Inversion Recovery):

  • Normal pancreas: low-to-intermediate signal

  • Inflammatory edema or pathology: bright hyperintensity

  • Fat suppressed → highlights edema and peripancreatic changes

T1 GRE Fat-Sat Pre-Contrast:

  • Normal tail: homogeneous intermediate signal

  • Tumors/cysts: hypointense compared to surrounding parenchyma

T1 GRE Fat-Sat Post-Gadolinium:

  • Normal tail: homogeneous, intense enhancement in early arterial phase

  • Adenocarcinoma: hypoenhancing lesion compared to parenchyma

  • Neuroendocrine tumors: often hyperenhancing in arterial phase

  • Cysts/pseudocysts: no internal enhancement, only thin rim if inflamed

CT Appearance

Non-Contrast CT:

  • Tail appears as soft tissue density near splenic hilum

  • Fat planes around spleen and kidney help define margins

  • Tumors: hypoattenuating masses; calcification may be present in chronic pancreatitis

Post-Contrast CT:

  • Normal pancreas: homogeneous intense enhancement in arterial phase

  • Adenocarcinoma: hypoattenuating lesion relative to pancreas

  • Neuroendocrine tumors: hyperattenuating lesions in arterial phase

  • Cysts: low-attenuation lesions with or without rim enhancement if infected/inflamed

MRI image

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MRI image

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CT image

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CT image

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