Ultrasonographic findings and differentiation of benign and malignant focal splenic lesions

The purpose of this study was to analyse the sonographic findings of focal splenic lesions with an attempt to differentiate benign lesions from malign ancies. The sonographic findings of 53 cases of verified focal splenic lesi ons, excluding posttraumatic haematomas and phleboliths, were retrospective ly analysed. Of the 53 cases, 30 cases (57%) were benign and 23 cases (43%) were malignant. The malignancies included lymphoma (n=13),metastases (n=10 ); while the benign lesions included cysts (n=17), infarcts (n=3), and absc esses (n=5), and one case each of haemangioma, hamartoma, spontaneous ruptu re, tuberculosis, and lymphangioma. Significant differences were noted betw een the benign and malignant groups with respect to the presence of solitar y lesions (p<0.0001), anechoic mass (p<0.0001), lesions with highly echogen ic foci due to gas or calcification (p = 0.0303), hyperechoic/ mixed echoic lesions (p<0.0001), presence of extrasplenic abdominal masses (p<0.0001), and nodules with the target sign (p<0.0001). Solitary lesions, anechoic mas s, and lesions with highly echogenic foci due to gas or calcification each had a positive predictive value of 85%, 100%, and 100%, respectively, for t he lesions to be benign. The multifocal/diffuse lesions, presence of extras plenic abdominal masses, hyperechoic/mixed echoic lesions, and nodules with the target sign each had a positive predictive value of 70%, 100%, 70%, an d 100%, respectively, for the lesions to be malignant. In summary, focal le sions with anechoic pattern or echogenic foci due to gas or calcification a re suggestive signs of benign process. The sonographic observations of mult ifocal or diffuse solid lesions, especially those associated with target si gn or extrasplenic abdominal masses are suggestive of malignancy.