Splenic Lesions: Clinical and Imaging Characteristics and Their Diagnostic Role

Background: Splenic lesions encompass a variety of benign, inflammatory, and malignant conditions that often present with nonspecific clinical symptoms. Imaging modalities play a crucial role in accurately diagnosing and characterizing these lesions to guide clinical management. Methods: A retrospective analysis of 1,200 patients with CT-confirmed splenic abnormalities was conducted at Al-Mouwasat University Hospital (2023–2025). Each patient also underwent ultrasonography for direct modality comparison. Clinical data, lesion type, and imaging characteristics were statistically evaluated to assess diagnostic accuracy. Results: Eighty percent of patients were male. Traumatic lesions (50%), splenomegaly (25%), and calcifications (10%) were most frequent; cysts (2%), accessory spleens (1%), and tumors (12%) were less common. CT detected 100% of calcifications, while ultrasound detected 90%. CT showed 100% sensitivity in vascular hilum evaluation versus 85% for Doppler ultrasound, with splenic vein thrombosis in 25.4% and non-visualization in 14.9%. Among 122 infarctions, causes included idiopathic (33%), atrial fibrillation (20%), and endocarditis (10%); large-pattern infarctions were most prevalent (65%). Accessory spleens appeared in 1% of cases, most commonly at the hilum. Conclusion: CT outperformed ultrasound in characterizing splenic lesions and detecting vascular complications. Accurate imaging is essential for guiding timely management and avoiding unnecessary interventions.