E2242. Imaging Overview of Splenic Masses and Mass-like Lesions: What the Radiologist Should Know
  1. Daniel Hynes; UMMS Baystate Medical Center
  2. Angelica Patino; UMMS Baystate Medical Center
  3. Daniel Kowal; UMMS Baystate Medical Center
Despite the spleen being the dominant hematolymphoid organ in the abdomen, evaluation is occasionally overlooked on cross-sectional imaging. Providing crucial hematological and immunologic functions, the spleen can harbour a wide range of occult pathology extending from infection, through storage disorders to neoplasm. Accurate lesion characterisation is critical to stratify appropriate management and deter unnecessary invasive diagnostic intervention. While often challenging to distinguish benign from malignant splenic lesions, we present common lesion characteristics to break down the diagnostic dilemma. We highlight splenic chameleons and how to discern them. Utilising CT, MR and ultrasound we evaluate the spectrum of splenic pathology in a pictorial analysis infrequently encountered in clinical practice

Educational Goals / Teaching Points
1. Review pathophysiology and epidemiology of splenic pathology. 2. Focused case discussion of benign and malignant lesions of the spleen with US, MRI and CT examples. Examples include lymphangioma, hamartoma, SANT, lymphoma, angiosarcoma. 3. Case-based review of infection and inflammatory lesions of the spleen including splenic abscess, fungal infection, granulomatous disease, hematologic and storage disorders. 4. Discuss best practice imaging techniques with advantages and limitations for evaluation of splenic masses. 5. Outline current ACR imaging appropriateness criteria, management guidelines and best practice follow-up recommendations.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Anatomical knowledge of the intricate mesh of lymphatic, hematologic and soft tissue planes in the peritoneum aids in localisation, characterisation and diagnosis of splenic masses. Ultrasound, CT and MRI all play a role in evaluation of the spleen. We define the useful case series where each modality can be optimally used for high diagnostic yield and benefit to the patient.

Accurate characterisation of abdominal wall lesions is imperative to expedite appropriate care for our patient. Understanding the disease process aids in examination modality choice to attain high yield information of the underlying condition.