• Incidental Splenic Lesions: A Proposed Algorithm for Assessment and Management

    Myles T. Taffel, MD, Julie Y. An, MD, Frank H. Miller, MD, Matthew N. Nazarian, MD, Meghan G. Lubner, MD, Amelia L. Kernizan, MD, and Sooah Kim, MD

    Abstract

    Although incidental splenic lesions are typically benign, they present a diagnostic challenge in that they lack specific imaging features and rarely receive pathologic confirmation. Whereas CT can suggest a diagnosis, abdominal MRI provides superior characterization using standard pulse sequences, dynamic contrast enhancement, and DWI sequences. In most cases, establishing the indolent nature of a lesion is more important than determining an exact diagnosis. Building on the American College of Radiology�s white paper on incidental findings, this Pictorial Essay focuses on lesions 1 cm or larger that are encountered on abdominal CT without a known history of malignancy and proposes a simple classification algorithm for management. We group incidental splenic lesions into four categories, ranging from definitively benign to likely malignant, with follow-up or intervention recommendations based on malignancy risk. This clinically based classification system offers clearer guidance on managing incidental splenic lesions and assists the radiologist in suggesting appropriate management strategies.