Diagnostic approach to splenic lesions

Abstract

Background Splenic lesions are rare and mostly incidental findings on cross-sectional imaging. Most lesions are of benign nature and can be correctly identified based on imaging characteristics. Further, invasive evaluation is only necessary in cases of splenic lesions with uncertain or potentially malignant etiology.

Method While in most cases a correct diagnosis can be made from computed tomography (CT), (additional) magnetic resonance imaging (MRI) can aid in the identification of lesions. As these lesions are rare, only a few of the differential diagnoses are regularly diagnosed in the clinical routine.

Result and Conclusion This review presents the differential diagnoses of splenic lesions, including imaging characteristics and a flowchart to determine the right diagnosis. In conjunction with laboratory results and clinical symptoms, histological workup is necessary only in a few cases, especially in incidental findings. In these cases, image-guided biopsies should be preferred over splenectomy, if possible.

Key Points 

• Splenic lesions are rare and are usually incidental findings on abdominal imaging

• CT imaging and MRI imaging are the diagnostic tools of choice for the further workup of splenic lesions

• Based on their image morphological characteristics, a large number of splenic lesions can be assigned to one entity and do not need histological analysis

Citation Format

• Krähling H, Seidensticker M, Heindel WL et al. Diagnostic approach to splenic lesions. Fortschr Röntgenstr 2024; 196: 573 – 581

Zusammenfassung

Hintergrund Milzläsionen sind seltene und zumeist inzidentelle Befunde in der Schnittbildgebung. Der Großteil dieser Läsionen sind benignen Ursprungs und können korrekt anhand der Charakteristika in der Bildgebung identifiziert werden, nur in Fällen unsicherer oder potenziell maligner Ätiologie ist eine invasive weitere Abklärung notwendig.

Methode Während in den meisten Fällen die korrekte Diagnose anhand einer Computertomographie (CT) gestellt werden kann, kann eine (zusätzliche) Magnet-Resonanz-Tomographie helfen, die Läsion richtig zu identifizieren. Da diese Läsionen selten sind, werden nur einige der Differenzialdiagnosen regelmäßig im klinischen Alltag diagnostiziert.

Ergebnisse und Schlussfolgerung In diesem Übersichtsartikel werden die Differenzialdiagnosen von Milzläsionen erörtert, basierend auf den Charakteristika in der Bildgebung; ein Fließschema unterstützt in der Diagnosestellung. In Verbindung mit laborchemischen Ergebnissen und etwaigen Symptomen ist nur in wenigen Fällen eine histologische Sicherung notwendig, insbesondere bei Zufallsbefunden. In diesen Fällen sollte die bildgestützte Biopsie vor der Splenektomie bevorzugt werden.

Kernaussagen 

• Milzläsionen sind selten und zumeist inzidentelle Nebenbefunde abdominaler Bildgebung.

• CT-und MR-Bildgebung sind die diagnostischen Mittel der Wahl zur weiteren Abklärung von Milzläsionen.

• Anhand ihrer bildmorphologischen Charakteristika lässt sich eine Vielzahl von Milzläsionen einer Entität zuordnen und benötigen keine histologische Abklärung.

Keywords

spleen - diagnostic radiology - CT - MR-imaging

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