What specialty should a patient with a splenic lesion on CT (Computed Tomography) abdomen be referred to?

Specialty Referral for Splenic Lesion on CT Abdomen

For a splenic lesion discovered incidentally on CT abdomen in a hemodynamically stable patient, refer to general surgery or surgical oncology for evaluation and management planning. 1, 2

Initial Assessment Framework

The appropriate specialty referral depends critically on the clinical context and lesion characteristics:

Trauma-Related Lesions

• Refer immediately to trauma surgery or acute care surgery if the splenic lesion is trauma-related, regardless of hemodynamic status 3
• Even hemodynamically stable trauma patients require surgical consultation, as contrast-enhanced CT is the gold standard for defining anatomic injury and guiding management decisions 3
• Trauma surgeons manage both operative and non-operative approaches, including coordination of angiography/angioembolization when indicated 3

Non-Trauma Incidental Lesions

For incidental splenic lesions discovered on routine imaging:

Primary referral to general surgery is appropriate because:

• Surgical evaluation determines whether the lesion requires intervention, observation, or further diagnostic workup 1, 2
• Surgeons coordinate advanced imaging (MRI, PET/CT) and image-guided biopsy when malignancy is suspected 2
• Surgical expertise is essential for managing potential complications including abscess formation, infarction with rupture risk, or hemorrhage 1

Consider hematology-oncology referral when:

• Imaging characteristics suggest lymphoma (the most common malignant splenic tumor) or other hematologic malignancy 4
• The patient has known hematologic disease with splenic involvement 1
• Multiple splenic lesions are present in the context of systemic disease 4

Consider interventional radiology consultation for:

• Splenic abscesses requiring percutaneous drainage in high-risk surgical candidates 1
• Vascular abnormalities identified on imaging that may benefit from angioembolization 3, 1

Lesion Characterization Guides Urgency

Urgent Surgical Referral Indicated For:

• Signs of splenic abscess (persistent fever, recurrent bacteremia, contrast-enhancing cystic lesions) 1, 2
• Evidence of splenic infarction with complications (rupture, hemorrhage, hemodynamic instability) 1
• Any hemodynamic instability or signs of active bleeding 3
• Peritonitis or other acute abdominal findings 3

Routine Surgical Referral Appropriate For:

• Hypodense lesions requiring differentiation between benign and malignant etiologies 4, 5
• Calcified lesions beyond simple granulomas that need pattern recognition analysis 5
• Lesions with indeterminate features on CT requiring MRI or biopsy 2
• Most incidental findings in stable patients can be evaluated outpatient 6

Common Pitfalls to Avoid

• Do not assume all hypodense splenic lesions are benign - while hemangiomas are the most common benign lesions and lymphoma the most common malignancy, clinical context and imaging features must guide evaluation 4
• Do not delay referral for trauma-related findings - even minor splenic injuries can progress to delayed rupture unpredictably 7
• Do not rely solely on CT grade to predict outcomes - injury grade, free fluid amount, and contrast blush do not reliably predict need for intervention 3
• Do not order obsolete nuclear medicine scans - these provide no diagnostic value for splenic lesions 1, 2

Practical Algorithm

1. Determine if trauma-related → Immediate trauma/acute care surgery referral 3
2. Assess hemodynamic stability → Unstable patients require emergency surgical consultation 3
3. Evaluate for infection/abscess → Urgent surgical referral if suspected 1, 2
4. Characterize lesion on imaging → Surgical referral for definitive diagnosis and management planning 2, 4
5. Consider hematology-oncology co-management → When systemic disease or lymphoma suspected 4

In stable patients with incidental findings, general surgery provides the most comprehensive initial evaluation and coordinates multidisciplinary care as needed.