WFUMB Position Paper—Incidental Findings, How to Manage: Spleen

Abstract

The World Federation for Ultrasound in Medicine and Biology (WFUMB) is addressing the issue of incidental findings (IFs) with a series of publications entitled "Incidental Imaging Findings-The Role of Medical Ultrasound." IFs are less commonly encountered in the spleen than in many other abdominal organs but remain a frequent dilemma in clinical practice. A histological diagnosis is rarely necessary for patient management. Many IFs, such as secondary spleens and splenic cysts, are harmless and do not require any further investigation. The diagnosis of many other focal splenic lesions is, however, often problematic. The following overview is intended to illustrate a variety of incidentally detected spleen pathologies such as size variants, shape variants, secondary spleens, focal splenic lesions and splenic calcifications. It should aid the examiner in establishing the diagnosis. Moreover, it should help the ultrasound practitioner decide which pathologies need no further investigation, those requiring interval imaging and cases in which immediate further diagnostic procedures are required.In patients with splenomegaly (>13 £ 6 cm), an imaging, clinical and laboratory evaluation is usually required to determine the underlying cause.Most congenital variants of the spleen, and accessory spleens, have characteristic ultrasound appearances and do not require further evaluation or follow-up.The use of ultrasound contrast microbubbles (contrast-enhanced ultrasound) is of particular value in ultrasound imaging of the spleen when an indeterminate incidental finding is encountered.Splenosis can be confidently diagnosed with contrast-enhanced ultrasound and usually requires no additional imaging or follow-up.The cause of an inhomogeneous splenic parenchyma must be clarified, especially to exclude sarcoidosis or lymphomatous infiltration. Incidental indeterminate focal splenic lesions (with the exception of simple cysts) are often best managed by an interval follow-up examination (initially after 3 months) unless there clearly malignant clinical or sonographic features.For splenic calcifications, including the "starry sky" spleen, no follow-up is necessary.

Evaluation and Classification of Incidentally Detected Splenic Lesions Based on B-Mode and Contrast-Enhanced Ultrasound

“…internal medicine) [7,8]. FSIs were defined as asymptomatic and unexpected splenic lesions discovered incidentally on B-US, unrelated to the presenting illness, according to the World Federation for Ultrasound in Medicine and Biology position paper on incidental splenic findings [6]. Wedge-shaped subcapsular lesions with absent enhancement on CEUS that were diagnosed as splenic infarcts were not included in the study [9].…”

“…1. The arterial enhancement (AE) of FSIs was categorized as hyperenhancement, isoenhancement, hypoenhancement, or absent enhancement [2,6,11,13]. The arterial phase was defined as the period from the earliest arrival of the contrast agent at the spleen until 60 seconds thereafter.…”

Incidental Findings in Pediatric Patients: How to Manage Liver Incidentaloma in Pediatric Patients

“…IFs on imaging studies are asymptomatic and unexpected pathologies, unrelated to the presenting illness. They often necessitate further imaging or diagnostic work-ups which entail both a psychological and an economic burden for the patient and the healthcare system [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 ].…”

“…The World Federation for Ultrasound in Medicine and Biology (WFUMB) is addressing the issue of incidental findings (IFs) with a series of publications titled “Incidental imaging findings—the role of ultrasound” [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 ]. Each WFUMB position paper on IFs will follow the same template and, accordingly, will be uniformly structured to help readers interpret the key messages [ 7 ], will discuss the prevalence and imaging features of hepatic incidental finding in pediatric patients and will discuss strategies for work- and follow-up.…”

Managing Incidental Findings Reported by Medical, Sonography and Other Students Performing Educational Ultrasound Examinations

“…Comprehensive reviews of IF in different organs and systems are being published in a series of position papers by the World Federation for Ultrasound in Medicine and Biology (Bialek, et al 2021, Lewicki, et al 2021, Trenker, et al 2021 to give recommendations on how to handle particular IF.…”