A diagnostic approach to splenic lesions and how to differen
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Most splenic lesions are detected incidentally, posing a challenge for both interpreting and referring physicians in determining the need for and type of further evaluation. Paluska et al1 found incidental splenic lesions in 1% of patients in an emergency room population undergoing computed tomography (CT) scans for abdominal pain or trauma.1 Most of these were considered clinically benign. However, in patients with a known malignancy or symptoms attributable to possible splenic pathology, the incidentally discovered splenic lesion may be more significant.

Clinical factors must be taken into account when evaluating a splenic lesion, most importantly pain attributable to the spleen, signs and symptoms of infection, immune status, history of known malignancy, associated findings on imaging of the chest, abdomen or pelvis and a history of abdominal trauma, either recent or remote. Certain laboratory values, such as white blood cell count, can also provide valuable information to narrow the differential diagnosis. In this article, the authors propose an algorithm based on clinical factors for narrowing the differential diagnosis of an incidental splenic mass.

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