Objective <p>This study aims to investigate the imaging features of epidermoid cysts within intrapancreatic accessory spleen (ECIPAS) to benefit the differential diagnosis of pancreatic cystic lesions.</p> Methods <p>We retrospectively reviewed the clinical, radiological and pathological data of 24 patients with pathologically confirmed ECIPAS. All cases underwent abdominal contrast-enhanced computed tomography (CE-CT) scans, with 4 cases further undergoing magnetic resonance cholangiopancreatography (MRCP). The imaging features of the lesions were analyzed.</p> Results <p>The majority of the patients were young to middle-aged with no apparent clinical symptoms. Over half of the masses exhibited circular, oval or unilocular architectures. On plain CT, the masses primarily displayed indistinct margins with an average diameter of 3.0 ± 1.1&#xa0;cm. Nineteen lesions were situated in the pancreatic tail, 1 in the head, 1 in the head-body junction, and 3 in the body. In the arterial phases of enhanced CT scans, the lesions exhibited varying degrees of enhancement: slight enhancement (<i>n</i> = 11), significant enhancement (<i>n</i> = 5), and no discernible enhancement (<i>n</i> = 8) compared to pancreatic parenchyma. On MRCP scan, all four lesions showed hyperintense on T2-weighted imaging (T₂WI).</p> Conclusion <p>ECIPAS is a rare benign lesion, with nearly half exhibiting slightly uneven enhancement on contrast-enhanced CT scans. Usually, the solid-portion-enriched lesions show similar enhancement to that of the spleen, aiding in the precise preoperative diagnosis. ECIPAS can manifest in various locations within the pancreas, including the tail, head, and body. Patients may benefit from improved quality of life by avoiding unnecessary surgeries.</p>