Imaging and Clinical Assessment of Incidentally Detected Splenic Lesions

Imaging Modality Selection

Contrast‑enhanced computed tomography (CT) is the reference imaging test for splenic lesions, providing a sensitivity and specificity of approximately 96 %–100 % for accurate lesion characterization. This high diagnostic performance supports its use as the first‑line study in patients with suspected splenic pathology. [1][2]
CT with intravenous contrast is recommended as the initial diagnostic tool for hemodynamically stable individuals when a splenic abnormality is suspected. It allows rapid assessment of lesion size, location, and enhancement pattern. [1][2]
Doppler ultrasound (DUS) and contrast‑enhanced ultrasound (CEUS) are valuable adjuncts for evaluating splenic vascularization and can be employed for serial follow‑up imaging. These modalities are especially useful when radiation exposure should be minimized or when CT is contraindicated. [1][2]

Heterogeneous or rim enhancement on contrast‑enhanced imaging should raise suspicion for infectious abscesses or malignant lesions. Such patterns warrant further diagnostic work‑up, potentially including tissue sampling. 1

The presence of splenomegaly is a key clinical parameter that influences the differential diagnosis of splenic lesions. Enlarged spleen size may suggest systemic or infiltrative processes. 2
A thorough patient history—including prior abdominal trauma, immunosuppressive status, or known malignancy—is essential for narrowing the differential and guiding management decisions. 1
Relevant laboratory abnormalities (e.g., abnormal blood counts or inflammatory markers) should be considered alongside imaging findings to refine diagnostic probability. 1