← All patterns
Splenic lesion(s)
AbdomenCT / MRI / US
Focal splenic lesion(s), usually incidental. Most are benign; multiplicity, enhancement and systemic context guide characterisation.
Differential
Cyst
common- •Well-defined fluid attenuation, no enhancement
- •Thin wall; may have peripheral calcification (post-traumatic)
Haemangioma
common- •Most common benign neoplasm; progressive/peripheral enhancement
- •T2-bright, may calcify
Hamartoma
less-common- •Solid, iso/hyperechoic mass with diffuse late enhancement
- •Often incidental, well-defined
Lymphoma
less-common- •Multiple hypoenhancing nodules or diffuse infiltration/splenomegaly
- •Adenopathy elsewhere; most common splenic malignancy
Metastases
rare- •Multiple lesions with a known primary (melanoma, breast, lung)
- •Usually late-stage disseminated disease
Abscess
rare- •Rim-enhancing collection ± gas; restricted diffusion
- •Febrile, immunocompromised or endocarditis
Key discriminators
- •Cystic vs solid; enhancement pattern
- •Single vs multiple
- •Systemic context (lymphoma, known primary, sepsis)
- •T2 signal and diffusion
- •Calcification
Work-up / next steps
- 1.Multiphase CT or MRI including delayed phase
- 2.Correlate with nodal disease and known malignancy
- 3.Ultrasound / diffusion MRI for cystic vs solid problem-solving
- 4.Biopsy or splenectomy for indeterminate solid masses
References
- Radiopaedia: Splenic lesions.
- Abbott RM et al. Primary vascular neoplasms of the spleen. RadioGraphics.
Educational clinical decision support only. This differential does not make a diagnosis, is not a medical device, and must never substitute for interpretation by a qualified radiologist correlated with the full clinical picture and prior imaging.