March 21, 2010

Solid Splenic Lesion

Fig.1: Axial T2 with fat saturation MR image shows a slightly T2 hyperintense lesion in the spleen (arrow).
Fig.2: Axial T1 post contrast with fat saturation reveals homogeneous enhancement of this lesion.

Splenic Lesion Approach
  • Solid versus cystic (distinguish by T2 signal intensity and enhancement pattern)
  • If solid, is it classic for hemangioma? Is there a history of malignancy elsewhere?
  • If cystic, usually represent false cyst (post-traumatic), congenital cyst, abscess

Solid Splenic Lesion
  • Benign tumors: hemangioma (most common benign tumor of spleen, same character as liver hemangioma), hamartoma
  • Malignant tumors: lymphoma, metastasis (history, multiplicity)
  • Others: sarcoidosis, langerhans cell histiocytosis
Our case: splenic metastasis from lung cancer [on imaging, this was not a cyst or hemangioma because its T2 signal was not as high as CSF. It enhanced so it definitely was solid. Differential diagnosis with this solitary solid lesion was hamartoma, solitary metastasis and primary malignancy. Lymphoma, sarcoidosis and LCH usually are multiple].

1. Davies SG. Chapman & Nakielny's Aids to Radiological Differential Diagnosis, 5th ed, 2009.
2. Elsayes KM, Narra VR, Mukundan G, et al. MR imaging of the spleen: spectrum of abnormalities. Radiographics 2005;25:967-982.

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