A 59-year-old woman had an abdominal ultrasound examination for vague abdominal pain. Except for a splenic lesion, no abnormality was demonstrated.

Figures 1A and B Splenic ultrasound with Doppler shows a rounded, well-defined echogenic mass, demonstrating some internal vascular flow. The features are characteristic of a hemangioma

DISCUSSION

Splenic hemangiomas are rare but remain the most common benign neoplasm of the spleen. They are usually discovered incidentally during ultrasonography performed for other reasons. Most tend to be small (< 2 cm), and can be single or multiple. In most cases, the blood flow to splenic hemangiomas is slow, and so they may appear on Doppler to be hypovascular. Ultrasonography is usually adequate for their diagnosis, sometimes with contrast sonography, but the equivocal cases should have MRI or CT for further evaluation.

Spontaneous rupture of splenic hemangiomas has been reported in up to 25% of cases, requiring splenectomy. Malignant degeneration may rarely occur. The differential diagnosis of splenic hemangiomas include: Littoral cell angioma, hemangiosarcoma and lymphomatous deposits.

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