Purpose or Case Report: While the most common abnormalities of the spleen are splenomegaly and trauma, many additional disease states can be manifested in the spleen which should be considered when evaluating the abdomen on cross sectional imaging. We composed a pictorial guide of a wide variety of variants and diseases for education and reference.

Methods & Materials: Illustrative cases of congenital, developmental, infectious, and neoplastic processes involving the spleen were chosen from the last fifteen years of abdominal sonography at our institution along with CT, MRI and pathologic correlation. Case examples include polysplenia, storage diseases, wandering spleen, torsed spleen, various cysts, siderotic nodules, splenic complications of sickle cell disease including autolysis, islands of residual splenic tissue and echogenic foci, hamartoma, various infections, hemangioma, and infiltrative diseases such as leukemia and lymphoma.

Results: Reviewing these cases provides an experience of a wide variety of splenic anatomic variants and pathology and improves the accuracy of interpretation.

Conclusions: A pictorial review of a wide variety of splenic anatomy and pathology improves the accuracy of interpretation.