Splenic haemangioma

Splenic haemangiomas, also known as splenic venous malformations, splenic cavernous malformations, or splenic slow flow venous malformations, while being rare lesions, are considered the second commonest focal lesion involving the spleen after simple splenic cysts 5,12 and the most common primary benign neoplasm of the spleen 6. They are usually found incidentally and have imaging appearances similar to hepatic haemangiomas. 

Please refer to the main article for a general discussion 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% 7-8,13.  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.

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.

Haemangiomas can have a variety of sonographic appearances depending on their exact histological composition (i.e. hypo, iso or hyperechoic). The dominant pattern, however, is considered to be a homogeneous echotexture that is predominantly hyperechoic 11.

  • usually does not demonstrate any intrinsic colour flow (~80% of cases) 11,13
  • contrast enhanced ultrasound: isoechogenicity to splenic parenchyma in all phases is the most frequent typical enhancement pattern of splenic haemangiomas observed on contrast-enhanced sonography 11

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.

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: hyperintense to splenic parenchyma
  • T1 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

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

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 an increased risk of haemorrhage; treatment then is usually a splenectomy.

  • hypersplenism 13
  • spontaneous rupture with haemorrhage is a risk with larger lesions
  • in some patients, they may cause the Kasabach-Merritt syndrome 8
  • malignant degeneration (rare) 13
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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