Hemangioma of the spleen: presentation, diagnosis, and management

Splenic hemangioma is a rare disorder but remains the most common benign neoplasm of the spleen. It often has a latent clinical picture; however, spontaneous rupture has been reported to occur in as many as 25% of this patient population.1 Treatment most often consists of splenectomy. This report reviews an 8-year experience with splenic hemangioma at Mayo Clinic. Thirty-two patients were identified with SH during the 8-year study period. The average age was 63 years (range 23 to 94 years) with 17 women and 15 men. Six patients presented with symptoms potentially related to the SH. The remainder (80%) were asymptomatic, and the SH was discovered incidentally during evaluation for other disorders. A mass or palpable spleen was appreciated in only four patients (12.5%). SHs ranged in size from 0.3 to 7 cm maximum diameter. A diagnosis of SH was made in 11 patients based on the findings of a splenic mass on computed tomography or ultrasound. Each of these SHs was < or =4 cm. Three of the 11 patients had multiple SHs. All 11 patients were managed successfully with observation. All but one of the patients remains asymptomatic, and no complications have developed during follow-up (range 0.6 to 7 years, mean 2.9 years). The diagnosis of splenic hemangioma was made at the time of surgery in the remaining 21 patients (65%). Splenectomy was performed for suspicion of primary or secondary splenic pathology. There were no instances of spontaneous rupture of the SH. Small splenic lesions, which meet the radiologic criteria for hemangiomas, may be safely observed.