Differential Diagnosis for Enhancing Lesions in the Spleen
Single Most Likely Diagnosis
- Splenosis: This condition, where multiple small splenic implants are found throughout the abdominal cavity, could potentially present with numerous enhancing lesions in the spleen itself, especially if the patient has a history of splenic trauma or surgery. However, the fact that the spleen size is normal and the lesions are described as within the spleen might lean more towards other diagnoses.
Other Likely Diagnoses
- Metastases: Metastatic disease to the spleen, although less common than to other organs like the liver or lungs, can present with multiple enhancing lesions. The spleen's normal size does not rule out metastatic disease.
- Lymphoma: Both primary and secondary (involvement of the spleen by systemic lymphoma) lymphoma can cause multiple lesions within the spleen. The enhancing pattern can vary but often shows some degree of enhancement, especially in the arterial phase.
- Sarcoidosis: This systemic granulomatous disease can involve the spleen, leading to the formation of granulomas that may appear as enhancing lesions on imaging. Sarcoidosis can affect multiple organs and often has a varied presentation.
Do Not Miss Diagnoses
- Angiosarcoma: A rare but aggressive primary splenic malignancy that can present with multiple enhancing lesions due to its vascular nature. It's crucial not to miss this diagnosis due to its poor prognosis and the need for prompt treatment.
- Infectious Diseases (e.g., Abscesses, Tuberculosis): Certain infectious diseases can cause multiple enhancing lesions in the spleen, especially in immunocompromised patients. These conditions require timely diagnosis and treatment to prevent severe outcomes.
Rare Diagnoses
- Histiocytosis: A group of rare diseases involving abnormal proliferation of histiocytes, which can affect the spleen and cause multiple lesions.
- Littoral Cell Angioma: A rare, benign vascular tumor of the spleen that can present as multiple enhancing lesions.
- Splenic Hemangiomas: Although more commonly found in the liver, hemangiomas can occur in the spleen and may appear as enhancing lesions, especially on contrast-enhanced imaging.