The imaging features in this case greatly overlap with sarcoidosis, the other major consideration for granulomatous inflammation of the spleen of this size/extent:

• small pulmonary nodules (incompletely imaged)
• splenic and hepatic involvement (the most common sites of abdominal sarcoidosis)
• mild retroperitoneal adenopathy

Ultimately, pathologic diagnosis with AFB staining was necessary to distinguish these two diagnoses. The patient was treated with splenectomy due to risk of rupture.