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35 yo/female patient presents with non-specific LBP. Mild LUQ discomfort is noted. 

No prior trauma,  surgeries,  carcinoma or corticosteroid regimen.

What do you see?

AP VIEW LUMBAR APINE.

4 typical lumbar VB are seen. At the lumbosacral junction, a LSTV (lumbar transitional VB) is present with a large spatulated TVP on the right with pseudoarthrosis and associated degenerative change. Did you see the curvilinear density of the LUQ?

XRAY FINDINGS

A ring enhanced radiolucency is present which measured 5.0 cm. on the original DICOM images. This lesion is intra-peritoneal. DX: Splenic cyst.

Non-contrast image of the abdomen with calcification within the wall of the splenic cyst.

https://radiopaedia.org/images/11228974– splenic cyst. the

  A cyst larger than 1 cm. in size requires MRI or needle biopsy follow-up. (3)

DISCUSSION: Incidental findings of splenic mass > 1.0 cm. generally are benign (85% of cases).
These cystic mass are usually pseudocysts and show no true endothelium on histologic examination but 1/2 of the cases show wall calcification. True epithelial cysts generally show enhancing internal septations & not likely wall calcification. (2) In this case, the 5.0 cm. size, warrants follow-up - either MRI or needle biopsy.

REFERENCES:

  1. https://appliedradiology.com/articles/a-diagnostic-approach-to-splenic-lesions 
  2. https://www.ajronline.org/doi/full/10.2214/AJR.19.22246
  3. https://radiopaedia.org/articles/incidental-splenic-lesion-an-approach

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