Splenic haemangioma

Splenic haemangiomas (also known as splenic venous malformations) while being rare lesions, are considered the second commonest focal lesion involving the spleen after simple splenic cysts 5,12.

Most splenic venous malformations are so called cavernous malformations, which are found throughout the body. This article focuses on splenic haemangiomas. For a general discussion please refer to the general article on cavernous venous malformation

It is important to note that according to newer nomenclature (ISSVA classification of vascular anomalies) these lesions are merely known as slow flow venous malformations. Having said that it is probably helpful in reports to include the word 'hemangioma' as this term is ubiquitous in the literature and most familiar to many clinicians. The remainder of this article uses the term 'splenic hemangioma' for consistency with the majority of the existing literature. 

Their autopsy prevalence rate is thought to range around 0.1-14% 7-8.  Most haemangiomas tend to be discovered in adults from mid-30s to mid-50s years of age 8.

The vast majority are asymptomatic and are incidentally discovered. Occasionally they may be associated with splenomegaly, abdominal pain, dyspnoea, diarrhoea, or constipation [ref needed].

Splenic hemangiomas are comprised of non-encapsulated non-neoplastic vascular channels of varying size ranging from capillary to cavernous, containing slow flowing blood. These vessels are lined with a single layer endothelium 2,8.

Associations
General

Most lesions tend to be small in size (< 2cm 12). Calcification if present, either central punctate or peripheral curvilinear, can be detected on radiographs or CT scans.

CT

Unenhanced CT scans can show a low-attenuation mass; following IV contrast, the vascular channels show centripetal fill( from the periphery inward). Larger lesions can fill more slowly and may do so incompletely and inhomogeneously 2.

Ultrasound

Haemangiomas can have a variety of sonographic appearances depending on their exact histological composition (i.e. hypo, iso or hyper echoic).

The dominant pattern however is considered to be a homogeneous echotexture that is predominantly hyperechoic 11.

Colour Doppler imaging

Usually does not demonstrate any intrinsic colour flow (~ 80% of cases) 11

Contrast enhanced sonography

Isoechogenicity to splenic parenchyma in all phases is the most frequent typical enhancement pattern of splenic haemangiomas observed on contrast-enhanced sonography 11.

MRI

Reported signal characteristics of most haemangiomas are similar to hepatic haemangiomas and are 6,10

  • T1 - iso to hypo-intense to normal splenic parenchyma
  • T2 - hyper-intense to splenic parenchyma
  • dynamic C+(Gd)
    • most demonstrate early nodular centripetal enhancement and uniform enhancement at delayed imaging
    • smaller lesions may however show homogeneous enhancement on immediate post-contrast acquisitions remaining enhanced on delayed images 12.
Angiography - DSA

Angiographic findings are non-specific (more content required).

Nuclear medicine

Nuclear imaging with 99mTc labelIed red cells shows slow accumulation of activity in the lesion followed by slow washout. Nuclear scans with 99mTc IabelIed sulphur colloid usually shows a photopenic defect due to the radionuclide accumulation being restricted to functional splenic tissue.

  • spontaneous rupture with haemorrhage is a risk with larger lesions
  • in some patients, they may cause the Kasabach-Merritt syndrome 8

They are benign lesions and carry no malignant potential. Their natural course is very slow growth over time 8. Haemangiomas are generally not treated unless they are symptomatic or very large, with increased risk of haemorrhage; treatment then is usually a splenectomy.


Vascular tumours and malformations
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Article Information

rID: 17918
Tag: cases
Synonyms or Alternate Spellings:
  • Splenic hemangioma
  • Haemangioma of the spleen
  • Hemangioma of the spleen
  • Hemangioma of spleen
  • Haemangioma of spleen
  • Splenic haemangiomas
  • Splenic hemangiomas
  • Splenic cavernous venous malformation
  • Splenic venous malformation

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