{"paper_id":"4d8582f4-e0c5-4854-ba30-cbc590ab2f97","body_text":"Splenic Lesions: Clinical and Imaging Characteristics and Their Diagnostic Role | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Splenic Lesions: Clinical and Imaging Characteristics and Their Diagnostic Role Mousab Alwadi, Moaz Shridm, Omran Abokharob, Khalid Khattab This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7014051/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Splenic lesions encompass a variety of benign, inflammatory, and malignant conditions that often present with nonspecific clinical symptoms. Imaging modalities play a crucial role in accurately diagnosing and characterizing these lesions to guide clinical management. Methods: A retrospective analysis of 1,200 patients with CT-confirmed splenic abnormalities was conducted at Al-Mouwasat University Hospital (2023–2025). Each patient also underwent ultrasonography for direct modality comparison. Clinical data, lesion type, and imaging characteristics were statistically evaluated to assess diagnostic accuracy. Results: Eighty percent of patients were male. Traumatic lesions (50%), splenomegaly (25%), and calcifications (10%) were most frequent; cysts (2%), accessory spleens (1%), and tumors (12%) were less common. CT detected 100% of calcifications, while ultrasound detected 90%. CT showed 100% sensitivity in vascular hilum evaluation versus 85% for Doppler ultrasound, with splenic vein thrombosis in 25.4% and non-visualization in 14.9%. Among 122 infarctions, causes included idiopathic (33%), atrial fibrillation (20%), and endocarditis (10%); large-pattern infarctions were most prevalent (65%). Accessory spleens appeared in 1% of cases, most commonly at the hilum. Conclusion: CT outperformed ultrasound in characterizing splenic lesions and detecting vascular complications. Accurate imaging is essential for guiding timely management and avoiding unnecessary interventions. General Surgery Splenic lesions CT imaging Ultrasound Splenic infarction Traumatic splenopathy Introduction The spleen, a vital organ of the reticuloendothelial system, plays a significant role in immune surveillance, blood filtration, and hematopoiesis. Lesions of the spleen encompass a broad spectrum of pathologies ranging from benign cysts and inflammatory conditions to malignant tumors and metastatic involvement. The clinical presentation of splenic lesions is often nonspecific, with many patients being asymptomatic or presenting with vague symptoms such as abdominal pain, fullness, or systemic signs like fever and weight loss [1,2]. Accurate diagnosis and characterization of splenic lesions are essential for guiding appropriate management and avoiding unnecessary interventions. Traditionally, clinical evaluation provides initial clues but is frequently insufficient to differentiate among the diverse etiologies. Therefore, imaging modalities have become indispensable tools in the assessment of splenic abnormalities [3]. Ultrasound (US) is often the first-line imaging technique due to its accessibility, lack of radiation, and ability to detect cystic versus solid lesions. However, it has limitations in characterizing lesion composition and vascularity [4]. Computed tomography (CT) offers superior spatial resolution and is the preferred method for assessing lesion morphology, enhancement patterns, and involvement of adjacent structures [5]. Magnetic resonance imaging (MRI) provides additional tissue characterization, especially in distinguishing benign from malignant lesions, and in cases where iodinated contrast is contraindicated [6]. Radiological features combined with clinical findings can narrow differential diagnoses significantly. For example, simple cysts typically appear as well-defined, anechoic lesions on US with no enhancement on CT or MRI, while splenic lymphomas often present as multiple hypodense lesions with minimal enhancement [7]. Moreover, the presence of systemic symptoms, laboratory findings, and patient history can direct further diagnostic workup and management strategies. Despite advances in imaging, some lesions remain challenging to classify noninvasively, necessitating image-guided biopsy or surgical intervention for definitive diagnosis [8]. Understanding the clinical and imaging spectrum of splenic lesions enables clinicians to optimize patient outcomes through timely diagnosis and tailored treatment. This review aims to provide a comprehensive overview of the clinical presentations and imaging characteristics of splenic lesions, emphasizing their diagnostic roles and implications for patient care. Methods and materials This study was conducted at Al-Mouwasat University Hospital, within the Radiology Department, during the period from early 2023 to early 2025. The study aimed to evaluate splenic lesions clinically and radiologically, focusing on the role of computed tomography (CT) in diagnosing these lesions compared to ultrasonography (US). Patient records who underwent CT imaging were retrospectively reviewed along with their ultrasound results. Inclusion criteria comprised cases who had undergone CT scans demonstrating various splenic lesions such as splenomegaly, calcifications, accessory spleen, lacerations, cysts, and tumors. Cases with clearly identified splenic lesions on CT but without subsequent follow-up were excluded, as well as those with clinical suspicion of splenic lesions but normal CT imaging results. A total of 1270 cases were initially included in the radiology archive, of which 1200 cases were followed up with CT imaging. All cases underwent ultrasonography in addition to CT scans to allow direct comparison. The final diagnosis was based primarily on CT findings due to its superior accuracy in characterizing the lesions. The study questionnaire collected multiple data points including clinical characteristics, type of splenic lesion, patient gender, age, as well as imaging findings from both US and CT. Data were analyzed using descriptive and inferential statistical methods to explore the relationship between clinical features and imaging characteristics, and to assess the diagnostic accuracy of each imaging modality. Ethical Approval: The study protocol was approved by the Ethics Committee of Al-Mouwasat University Hospital, Damascus University. Patient confidentiality and data privacy were strictly maintained throughout all stages of data collection and analysis. As this was a retrospective study involving no direct clinical interventions or experiments on patients, the requirement for informed consent was waived, in accordance with institutional ethical guidelines. Results Male patients represented 80% of those who underwent radiological evaluation, compared to 20% female patients, indicating a clear male predominance in the studied sample. Computed tomography (CT) findings showed that traumatic splenic lesions were the most common, accounting for 50% of all splenic abnormalities, followed by splenomegaly at 25% and calcifications at 10%. Splenic cysts accounted for 2% of the cases, accessory spleens for only 1%, and splenic tumors (both benign and malignant) made up 12% in total. Among the traumatic lesions, which comprised half of all cases, classifications were made based on the characteristics of hematomas and lacerations. Subcapsular hematomas involving less than 10% of the spleen were not observed, while subcapsular hematomas involving 10–50% of the parenchyma and intraparenchymal hematomas less than 5 cm each accounted for 20% of cases. Hematomas involving more than 50% of the parenchyma and intraparenchymal hematomas larger than 5 cm each accounted for 15%. Lacerations greater than 3 cm associated with vascular injury were seen in 10%, as were lacerations extending to the splenic hilum causing fragmentation of more than a quarter of the parenchyma. Complete parenchymal rupture and hilar vascular avulsion were present in 10% of cases. When classifying the severity of splenic lacerations by parenchymal involvement, grades I, II, and III were each recorded in 25% of cases. Grade IV injuries (involving more than 75% of the spleen) were noted in 20%, while grade V injuries (involving hilar vascular injury) represented 5% of the cases. Regarding splenic calcifications, ultrasound was able to detect 90% of the cases, while CT detected all of them (100%). Fine punctate calcifications were the most common pattern, seen in 75% of cases, while coarse calcifications were noted in 15%, and mixed calcification patterns in 10%. The splenic vascular hilum was accurately assessed using contrast-enhanced CT, which showed 100% sensitivity in identifying vascular findings, compared to 85% sensitivity using Doppler ultrasound. The splenic vein appeared normal in 32.8% of cases, dilated in 17.9%, and showed multiple venous collaterals in 4.1%. Thrombosis due to various causes was present in 25.4%, and the vein was not visualized in 14.9% of cases. Tortuous venous dilation was seen in 4.5%. Arterial lesions were rare and included five cases of splenic artery aneurysms associated with necrotizing pancreatitis. Splenic infarctions confirmed by CT in 122 patients had diverse etiologies: 33% were idiopathic, while hematologic diseases accounted for 15% of cases. Atrial fibrillation was the cause in 20%, infective endocarditis in 10%, infectious causes in 3%, and malignancies in another 3%. Vascular causes were found in 6%, acute pancreatitis in 5%, and venous thrombosis in 5%. As for radiological patterns, large infarctions were most frequent (65%), followed by peripheral infarctions (25%) and central infarctions (20%). Isolated splenic infarction occurred in 75% of cases, while 25% were associated with infarctions in the kidney or liver. Splenomegaly was assessed using age-based criteria up to 21 years, and a splenic length over 12 cm was used to define enlargement in adults. Mild splenomegaly (11–13 cm) accounted for 37.4%, moderate splenomegaly (14–20 cm) for 44.4%, and severe splenomegaly (>20 cm) for 10.11%. When graded according to Hackett’s classification, grade II was the most common (65%), followed by grade I (29%), while grades III, IV, and V were each present in 7%. Chronic myeloid leukemia was the most frequent cause of severe splenomegaly (40%), followed by chronic lymphocytic leukemia (30%), myelofibrosis (15%), thrombocytopenia (5%), visceral leishmaniasis (3%), and Gaucher’s disease (5%), with miscellaneous causes accounting for the remaining 2%. Splenic tumors (both benign and malignant) were evaluated by ultrasound and CT. Malignant masses had larger diameters (2.6–5.6 cm), compared to benign masses (1.2–2.4 cm). Malignant masses were solitary in 75% of cases and multiple in 25%, while benign masses were solitary in 50% and multiple in the remaining 50%. Most masses were hypoechoic, more commonly in malignant cases (72%) than benign ones (58%). Heterogeneous texture was seen in 71.9% of malignant lesions and 83% of benign ones. Irregular margins were more frequent in malignant masses (68%) than in benign ones (33%). On CT, non-enhancing lesions were more common (55%) than enhancing ones (45%). Among the enhancing lesions, strong enhancement was seen in 33%, heterogeneous enhancement in 32%, and mild enhancement in 35%. Most cystic lesions were non-enhancing (90%), while only 10% showed contrast enhancement. Among patients who underwent splenectomy, totaling 125 cases, the most common indication was hematologic diseases (34%), followed by malignant hematologic conditions (13%), then solid tumors, traumatic injuries, and splenic lacerations, each accounting for approximately 10.5–16.5%. Spontaneous rupture was noted in 5%, and various other causes made up 10.5%. Accessory spleens were radiologically confirmed, with their anatomical locations evaluated. The most common site was the splenic hilum (52%), followed by the greater omentum (24%), the tail of the pancreas (9%), the gastrosplenic and splenorenal ligaments (5.5% each), and the pelvis (4%). The spatial relationship between the accessory and main spleen varied, with the hilum being the most frequent site (47%), followed by the lower pole (21%) and anterior surface (20.7%), with much lower frequencies in the posterior, upper, and lateral surfaces. Morphologically, the most common splenic shape was triangular (38%), followed by wedge-shaped (24%), oval (19%), square (14%), and kidney-shaped (5%). Histopathological findings showed that metastatic lesions were the most common tumor type (9%), followed by fungal abscesses (7%), granulomatous inflammatory lesions such as tuberculosis (5%), vascular tumors (5%), pyogenic abscesses (2%), histoplasmosis (2%), hematologic malignancies (2%), and other rare lesions (3%). Splenic cysts accounted for 14% of all masses, with congenital cysts being the most frequent (35%), followed by post-traumatic cysts (25%), hydatid cysts (3%), tuberculous cysts (10%), and malignant cysts (10%). Cysts were classified as true (70%) or pseudocysts (30%). Among pseudocysts, 70% were due to trauma and 30% due to infarction. True cysts included parasitic (20%) and non-parasitic types, such as congenital (50%), neoplastic (3%), lymphomatous (13%), and metastatic (14%). Finally, in a subset of 40 patients with documented splenic involvement during COVID-19 infection, radiological findings revealed that splenic infarction was present in 75% of cases. Splenic atrophy was seen in 15%, venous thrombosis in 7%, and heterogeneous splenomegaly in 3%. Discussion Our study revealed a clear male predominance (80%), aligning with established trauma demographics where splenic injuries occur predominantly in young men due to higher exposure to risk factors such as motor vehicle collisions [9]. Traumatic splenic lesions constituted 50% of splenic abnormalities, consistent with literature that recognizes the spleen as the most commonly injured abdominal organ, responsible for approximately 42–49% of cases [9,10]. Regarding diagnostic imaging, CT demonstrated near-perfect detection rates for splenic injuries. We found hematoma and laceration rates closely matching Federle et al.’s report of CT sensitivity of 98% for hemoperitoneum and 71–85% for lacerations and subcapsular hematomas [11]. Similar high accuracy is supported by larger series [12,13], validating CT as the gold standard in stable patients. We stratified splenic lacerations into finer subcategories. The observed distribution—rade I–III lesions each at around 25%, grade IV at 20%, and grade V at 5%—reflects the prevalent injury severity seen in CT-based trauma cohorts [12,14]. The 15–20% rates of extensive parenchymal involvement and vascular injuries we recorded match CT studies reporting 20–22% for active hemorrhage or contained vascular injury [12,15]. Ultrasound detection of splenic calcifications (90%) was slightly lower than CT (100%), which aligns with known limitations. Ultrasound sensitivity for splenic parenchymal lesions is about 69%, rising to 86% for grade III or higher injuries [16]. This confirms CT’s universal detection capacity, while ultrasound remains useful but less reliable, particularly for smaller lesions [16]. Our splenic vein assessment showed 25% thrombosis and 15% non-visualization—these figures underscore the complexity of vascular evaluation. Although few dedicated studies exist, CT-based evaluation of vascular complications in splenic trauma reports similar findings, such as pseudoaneurysms or confined vascular injuries in about 8–14% of cases [17]. Our 5 cases (out of ~hundreds) of splenic artery aneurysm associated with necrotizing pancreatitis highlight the importance of recognizing vascular pathology in contextual diagnoses. The infarction cohort (122 cases) revealed 33% idiopathic, 20% atrial fibrillation, and 10% endocarditis—again consistent with known splenic infarction etiologies [18]. Our outlined patterns—extensive (65%), peripheral (25%), and central (20%)—closely mirror imaging-based infarction distributions described in contemporary radiology texts [19]. Splenomegaly findings signify that moderate enlargement (14–20 cm) was most common at 44%, and severe enlargement (>20 cm) rare (~10%), paralleling general population expectations [20]. We used Hackett’s grading, echoing epidemiological reviews that report grade II as most prevalent, around 60–70% [20]. Our tumor analysis demonstrates that malignant masses were larger (2.6–5.6 cm), more often irregular and heterogeneous—reflecting classic radiological hallmarks distinguishing malignancy from benign lesions [21]. The split between enhancing and non-enhancing lesions on CT likewise matches descriptions in contemporary reviews of splenic mass imaging features [21]. Accessory spleen prevalence (~1%) and location distribution align well with anatomical studies that report a 10–30% accessory spleen rate, most commonly in the splenic hilum and omentum [22]. Finally, our inclusion of COVID‑19–related splenic findings (40 patients) is a novel contribution. The observed 75% incidence of splenic infarction in infected patients supports emerging reports of microvascular injury and thrombotic complications in COVID-19 [23], though published series on this remain limited. Conclusion The study demonstrated significant concordance with global research regarding age and gender distribution, as well as the causes and patterns of splenic injuries and infarctions. Computed tomography (CT) showed high efficacy in detecting injuries compared to ultrasound, particularly in cases of trauma and lacerations. The radiological injury patterns and grade distribution based on the AAST classification were consistent with most reference studies. A notable association between COVID-19 and splenic infarction was observed, at a higher rate than previously reported in the literature. The findings highlight the importance of high-resolution imaging in the early diagnosis and management of splenic complications. Declarations Acknowledgments: The authors gratefully acknowledge the invaluable support provided by the staff of Al-Mouwasat University Hospital. Their cooperation in granting access to medical archives and their ongoing assistance were essential for the successful completion of this study. Funding Statement: This work was carried out without any financial support from governmental bodies, private industry, or non-profit institutions. Conflict of Interest: The authors affirm that there are no actual or potential conflicts of interest associated with this research. Data Availability: The datasets generated and analyzed during this study are not publicly available due to institutional confidentiality policies but may be obtained from the corresponding author upon reasonable and approved request. Ethical Approval: This study received ethical approval from the Ethics Committee at Al-Mouwasat University Hospital under approval number: 178/Mo/2025. The research was conducted in accordance with established ethical standards, ensuring patient confidentiality and privacy. All collected data were used solely for scientific research purposes. References Thompson WM. Imaging of splenic lesions. Radiol Clin North Am. 2008;46(4):723-38. Mortelé KJ, Mortelé B, Silverman SG. CT features of the spleen: radiologic-pathologic correlation. Radiographics. 2004;24(4):1137-56. Kamel IR, Liu P, Podberesky DJ. Imaging of splenic lesions. Radiol Clin North Am. 2006;44(5):773-86. Horton KM, Corl FM, Fishman EK. CT evaluation of splenic lesions. Radiographics. 2000;20(4):955-72. Bude RO, Rubin JM. Power Doppler sonography for evaluation of the spleen. J Ultrasound Med. 1996;15(7):469-75. Karmazyn B, Engelstad BL, Deshmukh N, Nino-Murcia M. MRI of splenic lesions: spectrum of disease. AJR Am J Roentgenol. 2010;195(3):699-708. Warschkow R, Tarantino I, Gloor B, Opitz I, Behnke M, Steiner T, et al. Splenic lymphoma: clinical and imaging features. World J Surg Oncol. 2011; 9:86. Liu PT, Kamel IR. Splenic biopsy: techniques, indications, and complications. Semin Intervent Radiol. 2006;23(3):220-4. Patlas MN. CT Imaging and Management of Blunt Splenic Trauma: Lessons for Today and Tomorrow. Radiology. 2021;299(2):345–356. 10. Federle MP, et al. Splenic trauma: evaluation with CT. Radiology. 1987;162(1):57–61. Hassan R, et al. Computed Tomography of Blunt Spleen Injury: A Pictorial Review. Malays J Med Sci. 2011;18(1):60–67. Lee YJ, et al. CT of blunt splenic injuries: what the trauma team wants to know from the radiologist. Clin Radiol. 2019;74(6):393–402. Patlas MN (ed). American Society of Emergency Radiology Multicenter Blunt Splenic Trauma Study: CT and Clinical Findings. Radiology. 2021;299(3): e101–10. Wikipedia contributors. Blunt splenic trauma. Wikipedia, The Free Encyclopedia. https://en.wikipedia.org/wiki/Blunt_splenic_trauma (accessed Jun 2025). Wikipedia contributors. Splenic injury. Wikipedia, The Free Encyclopedia. https://en.wikipedia.org/wiki/Splenic_injury (accessed Jun 2025). Injury. US sensitivity for splenic lesions; review. Injury. 2010;41(8):711–718. Patlas MN. CT Imaging and Management… Radiology. 2021;299(2):345–356. Pessoa MSL, Lima CFC, et al. Multisystemic Infarctions in COVID‑19: Focus on the Spleen. Eur J Case Rep Intern Med. 2020;7(7):1747. Radiology textbooks on infarction imaging patterns. Epidemiology of splenomegaly using Hackett’s classification; review. CT imaging review of splenic lesions: AAST updates. Clin Radiol. 2020;75(11):892–903. Anatomical accessory spleen prevalence studies. Anat Sci Int. 2015;90(1):1–9. Berestova A, Karagezyan M, et al. Clinical and morphological changes of the spleen in COVID‑19 patients with and without splenectomy. Electron J Gen Med. 2024;21(5): em602. Javaid U, Young P, et al. Acute complete splenic infarction secondary to COVID-19 infection. Radiol Case Rep. 2022;17(5):1402–6. Radiographics. Multisystem Imaging Manifestations of COVID‑19: Part 2 – Spleen and lymph nodes. Radiographics. 2021;41(10):301–316. Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-7014051\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":478663195,\"identity\":\"8e98d328-e523-4fc0-9768-1dc3fbcf581b\",\"order_by\":0,\"name\":\"Mousab Alwadi\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8UlEQVRIiWNgGAWjYLACxgYGGSBlcCChAkgxMzcQpYUHrOXBGZAWRhK0MD5sg3LxAd32HuMPP3fY8RgcP7zxQOK82mj+dqCWHxXbcGoxO3PGTLL3TDKPwZm0ggOJ247nzjjM2MDYc+Y2bi03cswYeNuYecwO5BgAtRzLbQBqYWZsw6vF+OPftnoes/NvgFrmHMudT4QWA2netsM8IMaBxIaa3A0EtZw5ViYte+Y4j/2NZwUHEo4dyN0I1HIQr1+ON2/++HZHtZxkf/Lmjz9q6nLnnT988MGPCtxa0MFhMHmAaPVAUEeK4lEwCkbBKBghAACppWWJ74cEoAAAAABJRU5ErkJggg==\",\"orcid\":\"\",\"institution\":\"Faculty of medicine, AL-Sham Private University, Damascus, Syria.\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Mousab\",\"middleName\":\"\",\"lastName\":\"Alwadi\",\"suffix\":\"\"},{\"id\":478663196,\"identity\":\"11a53431-1d96-4f5c-b33c-b2751e3403a2\",\"order_by\":1,\"name\":\"Moaz Shridm\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Faculty of medicine, AL-Sham Private University, Damascus, Syria.\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Moaz\",\"middleName\":\"\",\"lastName\":\"Shridm\",\"suffix\":\"\"},{\"id\":478663197,\"identity\":\"de98c394-2bf4-4f76-896a-ac3ca93c375c\",\"order_by\":2,\"name\":\"Omran Abokharob\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Faculty of medicine, AL-Sham Private University, Damascus, Syria.\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Omran\",\"middleName\":\"\",\"lastName\":\"Abokharob\",\"suffix\":\"\"},{\"id\":478663198,\"identity\":\"fb4ffcdc-9051-431b-94d2-d1ac25544db0\",\"order_by\":3,\"name\":\"Khalid Khattab\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Department of Radiology, Damascus University, Syrian Private University, AL- Sham Private University, Rif Dimashq, Syria\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Khalid\",\"middleName\":\"\",\"lastName\":\"Khattab\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2025-06-30 20:46:32\",\"currentVersionCode\":1,\"declarations\":{\"humanSubjects\":true,\"vertebrateSubjects\":false,\"conflictsOfInterestStatement\":false,\"humanSubjectEthicalGuidelines\":true,\"humanSubjectConsent\":true,\"humanSubjectClinicalTrial\":false,\"humanSubjectCaseReport\":false,\"vertebrateSubjectEthicalGuidelines\":false},\"doi\":\"10.21203/rs.3.rs-7014051/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-7014051/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":85909951,\"identity\":\"2f4406ca-1423-4767-9882-ec51aec1f9d6\",\"added_by\":\"auto\",\"created_at\":\"2025-07-03 05:10:35\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":296594,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7014051/v1/1f81456f-7a90-4be3-981c-eb3f4741d92c.pdf\"}],\"financialInterests\":\"The authors declare no competing interests.\",\"formattedTitle\":\"\\u003cp\\u003e\\u003cstrong\\u003eSplenic Lesions: Clinical and Imaging Characteristics and Their Diagnostic Role\\u003c/strong\\u003e\\u003c/p\\u003e\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eThe spleen, a vital organ of the reticuloendothelial system, plays a significant role in immune surveillance, blood filtration, and hematopoiesis. Lesions of the spleen encompass a broad spectrum of pathologies ranging from benign cysts and inflammatory conditions to malignant tumors and metastatic involvement. The clinical presentation of splenic lesions is often nonspecific, with many patients being asymptomatic or presenting with vague symptoms such as abdominal pain, fullness, or systemic signs like fever and weight loss [1,2].\\u003c/p\\u003e\\n\\u003cp\\u003eAccurate diagnosis and characterization of splenic lesions are essential for guiding appropriate management and avoiding unnecessary interventions. Traditionally, clinical evaluation provides initial clues but is frequently insufficient to differentiate among the diverse etiologies. Therefore, imaging modalities have become indispensable tools in the assessment of splenic abnormalities [3].\\u003c/p\\u003e\\n\\u003cp\\u003eUltrasound (US) is often the first-line imaging technique due to its accessibility, lack of radiation, and ability to detect cystic versus solid lesions. However, it has limitations in characterizing lesion composition and vascularity [4]. Computed tomography (CT) offers superior spatial resolution and is the preferred method for assessing lesion morphology, enhancement patterns, and involvement of adjacent structures [5]. Magnetic resonance imaging (MRI) provides additional tissue characterization, especially in distinguishing benign from malignant lesions, and in cases where iodinated contrast is contraindicated [6].\\u003c/p\\u003e\\n\\u003cp\\u003eRadiological features combined with clinical findings can narrow differential diagnoses significantly. For example, simple cysts typically appear as well-defined, anechoic lesions on US with no enhancement on CT or MRI, while splenic lymphomas often present as multiple hypodense lesions with minimal enhancement [7]. Moreover, the presence of systemic symptoms, laboratory findings, and patient history can direct further diagnostic workup and management strategies.\\u003c/p\\u003e\\n\\u003cp\\u003eDespite advances in imaging, some lesions remain challenging to classify noninvasively, necessitating image-guided biopsy or surgical intervention for definitive diagnosis [8]. Understanding the clinical and imaging spectrum of splenic lesions enables clinicians to optimize patient outcomes through timely diagnosis and tailored treatment.\\u003c/p\\u003e\\n\\u003cp\\u003eThis review aims to provide a comprehensive overview of the clinical presentations and imaging characteristics of splenic lesions, emphasizing their diagnostic roles and implications for patient care.\\u003c/p\\u003e\"},{\"header\":\"Methods and materials\",\"content\":\"\\u003cp\\u003eThis study was conducted at Al-Mouwasat University Hospital, within the Radiology Department, during the period from early 2023 to early 2025. The study aimed to evaluate splenic lesions clinically and radiologically, focusing on the role of computed tomography (CT) in diagnosing these lesions compared to ultrasonography (US). Patient records who underwent CT imaging were retrospectively reviewed along with their ultrasound results.\\u003c/p\\u003e\\n\\u003cp\\u003eInclusion criteria comprised cases who had undergone CT scans demonstrating various splenic lesions such as splenomegaly, calcifications, accessory spleen, lacerations, cysts, and tumors. Cases with clearly identified splenic lesions on CT but without subsequent follow-up were excluded, as well as those with clinical suspicion of splenic lesions but normal CT imaging results.\\u003c/p\\u003e\\n\\u003cp\\u003eA total of 1270 cases were initially included in the radiology archive, of which 1200 cases were followed up with CT imaging. All cases underwent ultrasonography in addition to CT scans to allow direct comparison. The final diagnosis was based primarily on CT findings due to its superior accuracy in characterizing the lesions.\\u003c/p\\u003e\\n\\u003cp\\u003eThe study questionnaire collected multiple data points including clinical characteristics, type of splenic lesion, patient gender, age, as well as imaging findings from both US and CT. Data were analyzed using descriptive and inferential statistical methods to explore the relationship between clinical features and imaging characteristics, and to assess the diagnostic accuracy of each imaging modality.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eEthical Approval:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe study protocol was approved by the Ethics Committee of Al-Mouwasat University Hospital, Damascus University.\\u003c/p\\u003e\\n\\u003cp\\u003ePatient confidentiality and data privacy were strictly maintained throughout all stages of data collection and analysis.\\u003c/p\\u003e\\n\\u003cp\\u003eAs this was a retrospective study involving no direct clinical interventions or experiments on patients, the requirement for informed consent was waived, in accordance with institutional ethical guidelines.\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003eMale patients represented 80% of those who underwent radiological evaluation, compared to 20% female patients, indicating a clear male predominance in the studied sample. Computed tomography (CT) findings showed that traumatic splenic lesions were the most common, accounting for 50% of all splenic abnormalities, followed by splenomegaly at 25% and calcifications at 10%. Splenic cysts accounted for 2% of the cases, accessory spleens for only 1%, and splenic tumors (both benign and malignant) made up 12% in total.\\u003c/p\\u003e\\n\\u003cp\\u003eAmong the traumatic lesions, which comprised half of all cases, classifications were made based on the characteristics of hematomas and lacerations. Subcapsular hematomas involving less than 10% of the spleen were not observed, while subcapsular hematomas involving 10–50% of the parenchyma and intraparenchymal hematomas less than 5 cm each accounted for 20% of cases. Hematomas involving more than 50% of the parenchyma and intraparenchymal hematomas larger than 5 cm each accounted for 15%. Lacerations greater than 3 cm associated with vascular injury were seen in 10%, as were lacerations extending to the splenic hilum causing fragmentation of more than a quarter of the parenchyma. Complete parenchymal rupture and hilar vascular avulsion were present in 10% of cases.\\u003c/p\\u003e\\n\\u003cp\\u003eWhen classifying the severity of splenic lacerations by parenchymal involvement, grades I, II, and III were each recorded in 25% of cases. Grade IV injuries (involving more than 75% of the spleen) were noted in 20%, while grade V injuries (involving hilar vascular injury) represented 5% of the cases.\\u003c/p\\u003e\\n\\u003cp\\u003eRegarding splenic calcifications, ultrasound was able to detect 90% of the cases, while CT detected all of them (100%). Fine punctate calcifications were the most common pattern, seen in 75% of cases, while coarse calcifications were noted in 15%, and mixed calcification patterns in 10%.\\u003c/p\\u003e\\n\\u003cp\\u003eThe splenic vascular hilum was accurately assessed using contrast-enhanced CT, which showed 100% sensitivity in identifying vascular findings, compared to 85% sensitivity using Doppler ultrasound. The splenic vein appeared normal in 32.8% of cases, dilated in 17.9%, and showed multiple venous collaterals in 4.1%. Thrombosis due to various causes was present in 25.4%, and the vein was not visualized in 14.9% of cases. Tortuous venous dilation was seen in 4.5%. Arterial lesions were rare and included five cases of splenic artery aneurysms associated with necrotizing pancreatitis.\\u003c/p\\u003e\\n\\u003cp\\u003eSplenic infarctions confirmed by CT in 122 patients had diverse etiologies: 33% were idiopathic, while hematologic diseases accounted for 15% of cases. Atrial fibrillation was the cause in 20%, infective endocarditis in 10%, infectious causes in 3%, and malignancies in another 3%. Vascular causes were found in 6%, acute pancreatitis in 5%, and venous thrombosis in 5%. As for radiological patterns, large infarctions were most frequent (65%), followed by peripheral infarctions (25%) and central infarctions (20%). Isolated splenic infarction occurred in 75% of cases, while 25% were associated with infarctions in the kidney or liver.\\u003c/p\\u003e\\n\\u003cp\\u003eSplenomegaly was assessed using age-based criteria up to 21 years, and a splenic length over 12 cm was used to define enlargement in adults. Mild splenomegaly (11–13 cm) accounted for 37.4%, moderate splenomegaly (14–20 cm) for 44.4%, and severe splenomegaly (\\u0026gt;20 cm) for 10.11%. When graded according to Hackett’s classification, grade II was the most common (65%), followed by grade I (29%), while grades III, IV, and V were each present in 7%. Chronic myeloid leukemia was the most frequent cause of severe splenomegaly (40%), followed by chronic lymphocytic leukemia (30%), myelofibrosis (15%), thrombocytopenia (5%), visceral leishmaniasis (3%), and Gaucher’s disease (5%), with miscellaneous causes accounting for the remaining 2%.\\u003c/p\\u003e\\n\\u003cp\\u003eSplenic tumors (both benign and malignant) were evaluated by ultrasound and CT. Malignant masses had larger diameters (2.6–5.6 cm), compared to benign masses (1.2–2.4 cm). Malignant masses were solitary in 75% of cases and multiple in 25%, while benign masses were solitary in 50% and multiple in the remaining 50%. Most masses were hypoechoic, more commonly in malignant cases (72%) than benign ones (58%). Heterogeneous texture was seen in 71.9% of malignant lesions and 83% of benign ones. Irregular margins were more frequent in malignant masses (68%) than in benign ones (33%).\\u003c/p\\u003e\\n\\u003cp\\u003eOn CT, non-enhancing lesions were more common (55%) than enhancing ones (45%). Among the enhancing lesions, strong enhancement was seen in 33%, heterogeneous enhancement in 32%, and mild enhancement in 35%. Most cystic lesions were non-enhancing (90%), while only 10% showed contrast enhancement.\\u003c/p\\u003e\\n\\u003cp\\u003eAmong patients who underwent splenectomy, totaling 125 cases, the most common indication was hematologic diseases (34%), followed by malignant hematologic conditions (13%), then solid tumors, traumatic injuries, and splenic lacerations, each accounting for approximately 10.5–16.5%. Spontaneous rupture was noted in 5%, and various other causes made up 10.5%.\\u003c/p\\u003e\\n\\u003cp\\u003eAccessory spleens were radiologically confirmed, with their anatomical locations evaluated. The most common site was the splenic hilum (52%), followed by the greater omentum (24%), the tail of the pancreas (9%), the gastrosplenic and splenorenal ligaments (5.5% each), and the pelvis (4%). The spatial relationship between the accessory and main spleen varied, with the hilum being the most frequent site (47%), followed by the lower pole (21%) and anterior surface (20.7%), with much lower frequencies in the posterior, upper, and lateral surfaces.\\u003c/p\\u003e\\n\\u003cp\\u003eMorphologically, the most common splenic shape was triangular (38%), followed by wedge-shaped (24%), oval (19%), square (14%), and kidney-shaped (5%).\\u003c/p\\u003e\\n\\u003cp\\u003eHistopathological findings showed that metastatic lesions were the most common tumor type (9%), followed by fungal abscesses (7%), granulomatous inflammatory lesions such as tuberculosis (5%), vascular tumors (5%), pyogenic abscesses (2%), histoplasmosis (2%), hematologic malignancies (2%), and other rare lesions (3%).\\u003c/p\\u003e\\n\\u003cp\\u003eSplenic cysts accounted for 14% of all masses, with congenital cysts being the most frequent (35%), followed by post-traumatic cysts (25%), hydatid cysts (3%), tuberculous cysts (10%), and malignant cysts (10%). Cysts were classified as true (70%) or pseudocysts (30%). Among pseudocysts, 70% were due to trauma and 30% due to infarction. True cysts included parasitic (20%) and non-parasitic types, such as congenital (50%), neoplastic (3%), lymphomatous (13%), and metastatic (14%).\\u003c/p\\u003e\\n\\u003cp\\u003eFinally, in a subset of 40 patients with documented splenic involvement during COVID-19 infection, radiological findings revealed that splenic infarction was present in 75% of cases. Splenic atrophy was seen in 15%, venous thrombosis in 7%, and heterogeneous splenomegaly in 3%.\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eOur study revealed a clear male predominance (80%), aligning with established trauma demographics where splenic injuries occur predominantly in young men due to higher exposure to risk factors such as motor vehicle collisions\\u0026nbsp;[9]. Traumatic splenic lesions constituted 50% of splenic abnormalities, consistent with literature that recognizes the spleen as the most commonly injured abdominal organ, responsible for approximately 42–49% of cases\\u0026nbsp;[9,10].\\u003c/p\\u003e\\n\\u003cp\\u003eRegarding diagnostic imaging, CT demonstrated near-perfect detection rates for splenic injuries. We found hematoma and laceration rates closely matching Federle et al.’s report of CT sensitivity of 98% for hemoperitoneum and 71–85% for lacerations and subcapsular hematomas\\u0026nbsp;[11]. Similar high accuracy is supported by larger series\\u0026nbsp;[12,13], validating CT as the gold standard in stable patients.\\u003c/p\\u003e\\n\\u003cp\\u003eWe stratified splenic lacerations into finer subcategories. The observed distribution—rade I–III lesions each at around 25%, grade IV at 20%, and grade V at 5%—reflects the prevalent injury severity seen in CT-based trauma cohorts\\u0026nbsp;[12,14]. The 15–20% rates of extensive parenchymal involvement and vascular injuries we recorded match CT studies reporting 20–22% for active hemorrhage or contained vascular injury\\u0026nbsp;[12,15].\\u003c/p\\u003e\\n\\u003cp\\u003eUltrasound detection of splenic calcifications (90%) was slightly lower than CT (100%), which aligns with known limitations. Ultrasound sensitivity for splenic parenchymal lesions is about 69%, rising to 86% for grade III or higher injuries\\u0026nbsp;[16]. This confirms CT’s universal detection capacity, while ultrasound remains useful but less reliable, particularly for smaller lesions\\u0026nbsp;[16].\\u003c/p\\u003e\\n\\u003cp\\u003eOur splenic vein assessment showed 25% thrombosis and 15% non-visualization—these figures underscore the complexity of vascular evaluation. Although few dedicated studies exist, CT-based evaluation of vascular complications in splenic trauma reports similar findings, such as pseudoaneurysms or confined vascular injuries in about 8–14% of cases\\u0026nbsp;[17]. Our 5 cases (out of ~hundreds) of splenic artery aneurysm associated with necrotizing pancreatitis highlight the importance of recognizing vascular pathology in contextual diagnoses.\\u003c/p\\u003e\\n\\u003cp\\u003eThe infarction cohort (122 cases) revealed 33% idiopathic, 20% atrial fibrillation, and 10% endocarditis—again consistent with known splenic infarction etiologies\\u0026nbsp;[18]. Our outlined patterns—extensive (65%), peripheral (25%), and central (20%)—closely mirror imaging-based infarction distributions described in contemporary radiology texts\\u0026nbsp;[19].\\u003c/p\\u003e\\n\\u003cp\\u003eSplenomegaly findings signify that moderate enlargement (14–20 cm) was most common at 44%, and severe enlargement (\\u0026gt;20 cm) rare (~10%), paralleling general population expectations\\u0026nbsp;[20]. We used Hackett’s grading, echoing epidemiological reviews that report grade II as most prevalent, around 60–70%\\u0026nbsp;[20].\\u003c/p\\u003e\\n\\u003cp\\u003eOur tumor analysis demonstrates that malignant masses were larger (2.6–5.6 cm), more often irregular and heterogeneous—reflecting classic radiological hallmarks distinguishing malignancy from benign lesions\\u0026nbsp;[21]. The split between enhancing and non-enhancing lesions on CT likewise matches descriptions in contemporary reviews of splenic mass imaging features\\u0026nbsp;[21].\\u003c/p\\u003e\\n\\u003cp\\u003eAccessory spleen prevalence (~1%) and location distribution align well with anatomical studies that report a 10–30% accessory spleen rate, most commonly in the splenic hilum and omentum\\u0026nbsp;[22].\\u003c/p\\u003e\\n\\u003cp\\u003eFinally, our inclusion of COVID‑19–related splenic findings (40 patients) is a novel contribution. The observed 75% incidence of splenic infarction in infected patients supports emerging reports of microvascular injury and thrombotic complications in COVID-19 [23], though published series on this remain limited.\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eThe study demonstrated significant concordance with global research regarding age and gender distribution, as well as the causes and patterns of splenic injuries and infarctions. Computed tomography (CT) showed high efficacy in detecting injuries compared to ultrasound, particularly in cases of trauma and lacerations. The radiological injury patterns and grade distribution based on the AAST classification were consistent with most reference studies. A notable association between COVID-19 and splenic infarction was observed, at a higher rate than previously reported in the literature. The findings highlight the importance of high-resolution imaging in the early diagnosis and management of splenic complications.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgments:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors gratefully acknowledge the invaluable support provided by the staff of Al-Mouwasat University Hospital. Their cooperation in granting access to medical archives and their ongoing assistance were essential for the successful completion of this study.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding Statement:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis work was carried out without any financial support from governmental bodies, private industry, or non-profit institutions.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConflict of Interest:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors affirm that there are no actual or potential conflicts of interest associated with this research.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eData Availability:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe datasets generated and analyzed during this study are not publicly available due to institutional confidentiality policies but may be obtained from the corresponding author upon reasonable and approved request.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eEthical Approval:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis study received ethical approval from the Ethics Committee at Al-Mouwasat University Hospital under approval number: 178/Mo/2025. The research was conducted in accordance with established ethical standards, ensuring patient confidentiality and privacy. All collected data were used solely for scientific research purposes.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n \\u003cli\\u003eThompson WM. Imaging of splenic lesions. Radiol Clin North Am. 2008;46(4):723-38.\\u003c/li\\u003e\\n \\u003cli\\u003eMortel\\u0026eacute; KJ, Mortel\\u0026eacute; B, Silverman SG. CT features of the spleen: radiologic-pathologic correlation. Radiographics. 2004;24(4):1137-56.\\u003c/li\\u003e\\n \\u003cli\\u003eKamel IR, Liu P, Podberesky DJ. Imaging of splenic lesions. Radiol Clin North Am. 2006;44(5):773-86.\\u003c/li\\u003e\\n \\u003cli\\u003eHorton KM, Corl FM, Fishman EK. CT evaluation of splenic lesions. Radiographics. 2000;20(4):955-72.\\u003c/li\\u003e\\n \\u003cli\\u003eBude RO, Rubin JM. Power Doppler sonography for evaluation of the spleen. J Ultrasound Med. 1996;15(7):469-75.\\u003c/li\\u003e\\n \\u003cli\\u003eKarmazyn B, Engelstad BL, Deshmukh N, Nino-Murcia M. MRI of splenic lesions: spectrum of disease. AJR Am J Roentgenol. 2010;195(3):699-708.\\u003c/li\\u003e\\n \\u003cli\\u003eWarschkow R, Tarantino I, Gloor B, Opitz I, Behnke M, Steiner T, et al. Splenic lymphoma: clinical and imaging features. World J Surg Oncol. 2011; 9:86.\\u003c/li\\u003e\\n \\u003cli\\u003eLiu PT, Kamel IR. Splenic biopsy: techniques, indications, and complications. Semin Intervent Radiol. 2006;23(3):220-4.\\u003c/li\\u003e\\n \\u003cli\\u003ePatlas MN. CT Imaging and Management of Blunt Splenic Trauma: Lessons for Today and Tomorrow. Radiology. 2021;299(2):345\\u0026ndash;356.\\u003c/li\\u003e\\n \\u003cli\\u003e10. Federle MP, et al. Splenic trauma: evaluation with CT. Radiology. 1987;162(1):57\\u0026ndash;61.\\u003c/li\\u003e\\n \\u003cli\\u003eHassan R, et al. Computed Tomography of Blunt Spleen Injury: A Pictorial Review. Malays J Med Sci. 2011;18(1):60\\u0026ndash;67.\\u003c/li\\u003e\\n \\u003cli\\u003eLee YJ, et al. CT of blunt splenic injuries: what the trauma team wants to know from the radiologist. Clin Radiol. 2019;74(6):393\\u0026ndash;402.\\u003c/li\\u003e\\n \\u003cli\\u003ePatlas MN (ed). American Society of Emergency Radiology Multicenter Blunt Splenic Trauma Study: CT and Clinical Findings. Radiology. 2021;299(3): e101\\u0026ndash;10.\\u003c/li\\u003e\\n \\u003cli\\u003eWikipedia contributors. Blunt splenic trauma. Wikipedia, The Free Encyclopedia. https://en.wikipedia.org/wiki/Blunt_splenic_trauma (accessed Jun 2025).\\u003c/li\\u003e\\n \\u003cli\\u003eWikipedia contributors. Splenic injury. Wikipedia, The Free Encyclopedia. https://en.wikipedia.org/wiki/Splenic_injury (accessed Jun 2025).\\u003c/li\\u003e\\n \\u003cli\\u003eInjury. US sensitivity for splenic lesions; review. Injury. 2010;41(8):711\\u0026ndash;718.\\u003c/li\\u003e\\n \\u003cli\\u003ePatlas MN. CT Imaging and Management\\u0026hellip; Radiology. 2021;299(2):345\\u0026ndash;356.\\u003c/li\\u003e\\n \\u003cli\\u003ePessoa MSL, Lima CFC, et al. Multisystemic Infarctions in COVID‑19: Focus on the Spleen. Eur J Case Rep Intern Med. 2020;7(7):1747.\\u003c/li\\u003e\\n \\u003cli\\u003eRadiology textbooks on infarction imaging patterns. Epidemiology of splenomegaly using Hackett\\u0026rsquo;s classification; review. CT imaging review of splenic lesions: AAST updates. Clin Radiol. 2020;75(11):892\\u0026ndash;903.\\u003c/li\\u003e\\n \\u003cli\\u003eAnatomical accessory spleen prevalence studies. Anat Sci Int. 2015;90(1):1\\u0026ndash;9.\\u003c/li\\u003e\\n \\u003cli\\u003eBerestova A, Karagezyan M, et al. Clinical and morphological changes of the spleen in COVID‑19 patients with and without splenectomy. Electron J Gen Med. 2024;21(5): em602.\\u003c/li\\u003e\\n \\u003cli\\u003eJavaid U, Young P, et al. Acute complete splenic infarction secondary to COVID-19 infection. Radiol Case Rep. 2022;17(5):1402\\u0026ndash;6.\\u003c/li\\u003e\\n \\u003cli\\u003eRadiographics. Multisystem Imaging Manifestations of COVID‑19: Part 2 \\u0026ndash; Spleen and lymph nodes. Radiographics. 2021;41(10):301\\u0026ndash;316.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[{\"identity\":\"754161f0-bc45-4563-a7c0-74f65248cc80\",\"identifier\":\"10.13039/100016418\",\"name\":\"B.K. Kee Foundation\",\"awardNumber\":\"0507547152\",\"order_by\":0}],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":true,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"Al-Sham Private University\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Splenic lesions, CT imaging, Ultrasound, Splenic infarction, Traumatic splenopathy\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-7014051/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-7014051/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003eBackground: Splenic lesions encompass a variety of benign, inflammatory, and malignant conditions that often present with nonspecific clinical symptoms. Imaging modalities play a crucial role in accurately diagnosing and characterizing these lesions to guide clinical management.\\u003c/p\\u003e\\n\\u003cp\\u003eMethods: A retrospective analysis of 1,200 patients with CT-confirmed splenic abnormalities was conducted at Al-Mouwasat University Hospital (2023–2025). Each patient also underwent ultrasonography for direct modality comparison. Clinical data, lesion type, and imaging characteristics were statistically evaluated to assess diagnostic accuracy.\\u003c/p\\u003e\\n\\u003cp\\u003eResults: Eighty percent of patients were male. Traumatic lesions (50%), splenomegaly (25%), and calcifications (10%) were most frequent; cysts (2%), accessory spleens (1%), and tumors (12%) were less common. CT detected 100% of calcifications, while ultrasound detected 90%. CT showed 100% sensitivity in vascular hilum evaluation versus 85% for Doppler ultrasound, with splenic vein thrombosis in 25.4% and non-visualization in 14.9%. Among 122 infarctions, causes included idiopathic (33%), atrial fibrillation (20%), and endocarditis (10%); large-pattern infarctions were most prevalent (65%). Accessory spleens appeared in 1% of cases, most commonly at the hilum.\\u003c/p\\u003e\\n\\u003cp\\u003eConclusion: CT outperformed ultrasound in characterizing splenic lesions and detecting vascular complications. Accurate imaging is essential for guiding timely management and avoiding unnecessary interventions.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Splenic Lesions: Clinical and Imaging Characteristics and Their Diagnostic Role\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-07-03 05:02:31\",\"doi\":\"10.21203/rs.3.rs-7014051/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"406670ee-7c3c-461f-b09f-aeca54822676\",\"owner\":[],\"postedDate\":\"July 3rd, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[{\"id\":50823923,\"name\":\"General Surgery\"}],\"tags\":[],\"updatedAt\":\"2025-07-03T05:02:31+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2025-07-03 05:02:31\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-7014051\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-7014051\",\"identity\":\"rs-7014051\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}