From the Research
For most patients with an incidentally discovered splenule, routine follow-up is not necessary, as splenules are generally benign and do not require treatment or ongoing monitoring. However, if the splenule was discovered during evaluation for another condition or if there are any concerning features, a one-time follow-up ultrasound in 6-12 months may be recommended to ensure stability, as suggested by the principles of monitoring for potential complications 1.
If follow-up imaging is performed, ultrasound is typically the preferred modality due to its lack of radiation exposure and cost-effectiveness, as highlighted in a study on estimating spleen size with hand-carried ultrasound 2. CT or MRI might be used in specific cases where ultrasound visualization is inadequate or if there are particular concerns about the splenule's characteristics, such as atypical imaging features or rapid growth.
Patients should be informed that splenules are common anatomical variants and usually do not cause any symptoms or health issues. They should be advised to report any new abdominal pain or swelling, particularly in the left upper quadrant, as these could potentially indicate complications, though such occurrences are rare. The use of contrast-enhanced ultrasonography, as discussed in a pictorial essay on splenic lesions 3, may aid in the characterization of the splenule and differentiation from other lesions, but this would typically be reserved for cases with specific concerns.
More frequent or intensive follow-up may be warranted in cases where the splenule is unusually large (typically >2-3 cm), shows rapid growth, or has atypical imaging features. In these instances, consultation with a specialist, such as a hematologist or surgeon, may be appropriate to determine the best course of action, considering the potential for the splenule to be mistaken for a lymph node or other structure in future medical procedures.
The presence of a splenule does not typically require any lifestyle modifications or precautions. However, patients should be aware of its existence in case of future abdominal surgeries or medical procedures. The awareness of splenule presence is crucial for avoiding unnecessary interventions, as highlighted by a study on endoscopic ultrasound-guided fine needle aspiration of accessory spleen 1, which shows the importance of accurate diagnosis to prevent mismanagement.
In terms of specific follow-up recommendations, the most recent and highest quality evidence does not provide a clear consensus on the optimal follow-up schedule for splenules. However, based on the principles of minimizing harm and maximizing benefit, a one-time follow-up ultrasound in 6-12 months is a reasonable approach for most patients, with further management tailored to individual patient factors and clinical judgment 4.