Most incidental splenic lesions are benign (cyst, haemangioma, hamartoma, infarct); the report separates the simple from the one that needs work-up — solid, growing, multiple with systemic features — and names lymphoma, metastasis and abscess when they fit.
Orient first
- Cysts, haemangiomas and hamartomas are common incidental findings; splenic metastases are rare and usually with widespread disease.
- Lymphoma is the commonest splenic malignancy — splenomegaly or multiple hypoattenuating nodules.
- Wedge-shaped peripheral defects in the arterial or portal phase are infarcts.
Acquire the study
- Curvilinear probe, left intercostal views with the patient in the right decubitus position.
The manoeuvre
- Anechoic, thin-walled lesion with posterior enhancement = simple cyst.
- Hyperechoic well-defined lesion = likely haemangioma; hypoechoic nodules in an enlarged spleen = lymphoma pattern.
- Colour Doppler: internal flow in a solid lesion.
What confirms it
- A lesion with the definitive features of a cyst, haemangioma or infarct needs no further work-up.
What licenses you to exclude it
- A solid, enlarging or symptomatic lesion without a benign pattern cannot be dismissed — recommend MRI or tissue in context.
The classic misread
- Missing small lesions at the splenic tip under rib shadowing.