Accessory spleen is a common congenital anomaly. There are currently no endoscopic ultrasound criteria for the diagnosis or differentiation of this benign splenic anomaly from pathologic disorders including neoplasms. Accessory spleen and splenic lobulation can be misinterpreted as neoplasm by endoscopic ultrasound. Although homogenous, they can be hyperechoic or hypoechoic [1]. Accessory spleen has been known to rupture [2].