Radiologic-Pathologic Conferences of the Massachusetts General Hospital

Splenic Hemangioma
David G. Disler1 and Felix S. Chew
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During staging of prostatic carcinoma in a 70-year-old man, a or gastric fluid, because of long T2 relaxation times; this quality
round, well-defined splenic mass was discovered on abdominal CT. generally distinguishes hemangioma from solid neoplasms [2]. How-
The lesion had a peripheral zone of slightly decreased attenuation ever, regions of liquefied necrosis in solid tumors will be bright on
and an irregular central zone of greater attenuation (Fig. 1 ). The lesion T2-weighted MR images also [2].
was hyperintense on T2-weighted MR images. The abdomen was Most splenic hemangiomas are discovered incidentally, and their
otherwise normal. The differential diagnosis included metastasis, clinical importance generally lies in differentiating them from other
primary benign or malignant neoplasm, lymphoma, and abscess. After conditions, particularly from metastases. Occasionally they may be
splenectomy, the gross pathologic examination revealed a 4.5-cm associated with splenomegaly, abdominal pain, dyspnea, diarrhea, or
nodule composed of whitish, focally hemorrhagic tissue. The final constipation. Spontaneous rupture with hemorrhage is a risk with
pathologic diagnosis was cavernous hemangioma. larger lesions [3]. No potential for malignancy exists. Hemangiomas
A cavernous hemangioma is an unencapsulated mass of dilated, are not treated unless they are symptomatic or very large, with
endothelially lined vascular channels filled with slowly flowing blood increased risk of hemorrhage; treatment is splenectomy. Histologic
[1]. Typically 1-2 cm in diameter, a hemangioma can be much larger. examination is occasionally necessary for diagnosis. Although un-
Sonograms may show an inconsistent and nonspecific appearance usual, hemangioma is nonetheless the most common primary splenic
of echogenicity and sharp margination, sometimes with cystic re- neoplasm.
gions. Unenhanced CT shows a low-attenuation mass; with IV con-
trast infusion, the vascular channels slowly fill from the periphery REFERENCES
inward. Larger lesions fill more slowly and may do so incompletely
1 . Ros PR, Moser RP Jr, Dachman AH, Murari PJ, Olmsted WW. Heman-
and inhomogeneously. Similarly, because of the slow blood flow,
gioma of the spleen: radiologic-pathologic correlation in ten cases. Radiol-
nuclear imaging with Tc-labeIed RBCs shows slow accumulation
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of activity in the lesion followed by slow washout. Nuclear scans with 2. Hahn PF, Weissleder R, Stark DD, Saini 5, Elizondo G, Ferrucci JT. MR
s9mTcIabeIed sulfur colloid show a photopenic defect because the imaging of focal splenic tumors. AJR 1988;150:823-827
radionuclide is accumulated only by the functional splenic tissue. T2- 3. Husni EA. The clinical course of splenic hemangioma. Arch Surg
weighted MR images show bright signal similar to that of bile, CSF, 1961;83:681 -688

Fig. 1.-Splenic hemangioma.

A, unenhanced CT scan shows a round splenic lesion with lower attenuation in center (long arrow) than in periphery (short arrows).
B, Proton density-weighted MR image shows that center has low signal intensity but periphery is nearly isointense with spleen.
C, Lesion becomes bright on T2-weighted MR image.
D, Cut surface of gross specimen shows an unencapsulated hemorrhagic lesion (arrows) with central stellate scar.

From the weekly radiologic-pathologic correlation conferences conducted by Jack Wittenberg. Pathology editor: Andrew E. Rosenberg. Radiology editors:
William E. Palmer, Daniel P. Barboriak, Daniel I. Rosenthal, Felix S. Chew.
‘Both authors: Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 32 Fruit St., Boston, MA 02114. Address reprints
requests to F. S. Chew.
AJR 157:44, July 1991 0361-803X/91/1571-0044 © American Roentgen Ray Society