From the Research
A 1.5 centimeter splenic hemangioma found incidentally on abdominal ultrasound in an asymptomatic 72-year-old patient generally requires no specific treatment or intervention. These lesions are benign vascular tumors and are the most common non-cancerous lesions of the spleen. At this small size and without symptoms, the recommended approach is observation only, as supported by studies such as 1, which suggests that small splenic lesions meeting the radiologic criteria for hemangiomas may be safely observed.
Key Considerations
- The patient should be informed about the benign nature of the finding to alleviate any concerns.
- Follow-up imaging may be considered in 6-12 months to ensure stability, though many experts consider even this unnecessary for typical-appearing hemangiomas under 2 cm, as noted in 2.
- The natural history of splenic hemangiomas is that they rarely grow significantly or cause complications, with spontaneous rupture being extremely uncommon, especially for small lesions under 4 cm, as discussed in 1.
Management Approach
- No medications, procedures, or surgical interventions are necessary for asymptomatic patients with small splenic hemangiomas.
- The only circumstances that would warrant reconsideration of this conservative approach would be if the patient develops symptoms specifically attributable to the lesion, such as left upper quadrant pain, or if subsequent imaging shows significant growth or atypical features, as might be suggested by cases like 3, though this case involves a different type of hemangioma and a younger patient.
Evidence Summary
Studies such as 1, 2 support the observation that small splenic hemangiomas are benign and can be managed conservatively. More recent studies like 4 discuss advanced surgical techniques for symptomatic cases or larger lesions but do not alter the approach for small, asymptomatic hemangiomas. Older studies like 5 provide radiologic-pathologic correlations that aid in diagnosis but do not change the management approach for small, incidentally found hemangiomas. The most recent and relevant evidence, such as 1 and 2, guides the recommendation for observation without intervention for small, asymptomatic splenic hemangiomas.