Purpose or Case Report: The spleen is frequently involved in a wide range of pathological processes, yet is insufficiently addressed in the radiology literature for the pediatric population. Understanding the embryological development of the spleen – originating as a mesodermal derivative that initially manifests as a condensation of mesenchymal cells within the dorsal mesogastrium and later translocates to the left side of the abdominal cavity as the stomach rotates – and recognizing its normal appearance in imaging methods are crucial for the accurate diagnosis of pathological processes. These processes vary from focal to diffuse spleen involvement and include anatomical variants (e.g., splenunculus), variations in size (e.g., splenomegaly), in number (e.g., polysplenia and asplenia), and in location (e.g., wandering spleen), as well as vascular (e.g., hemangioma and infarction), traumatic (e.g., lacerations), infectious (e.g., abscess), genetic (e.g., sickle cell disease) and neoplastic abnormalities (e.g., lymphoma and metastasis). Ultrasound is typically the first imaging modality in evaluating the spleen and its lesions; however, CT can provide detailed information in some contexts (e.g., trauma), and MRI offers excellent soft tissue contrast and is useful in cases requiring etiology differentiation (e.g., tumor). Therefore, it is important to understand how these different entities present in different imaging modalities, and what makes them unique. We aim to provide a comprehensive overview of spleen embryological development, and a visual differentiation of both common and uncommon splenic lesions in the pediatric population, highlighting high-yield clinical cases that illustrate key findings.
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Conclusions: Understanding the embryology of the spleen, its normal appearance, and various imaging characteristics of spleen lesions in children is crucial for the diagnosis and management of these patients. It is also important to look for additional findings, as they can assist in distinguishing between differential diagnoses. Timely and accurate interpretation of imaging results can greatly impact treatment decisions and ultimately enhance patient clinical outcomes.