Aim: This study analyzes frequency, sonographic pattern and differential diagnosis of echogenic splenic foci and the value of ultrasound follow-up examinations.
Method: Clinical data and ultrasound examinations of 137 patients with echogenic splenic foci were evaluated. Patients with uncertain diagnosis were identified and underwent a second examination (n = 31).
Results: Echogenic splenic foci are extremely rare. We found 137 cases in 12 1/2 years (12.2 of 10,000 ultrasound examinations). 5 sonographic patterns with differing but characteristic differential diagnosis were seen (round echogenic, round echogenic with halo and/or central liquefaction, round predominantly echogenic with hypoechoic parts, echogenic wedge-form, calcifications or gas). In patients with underlying malignant disorders the splenic foci were benign in 26 cases (34.7%), malignant in 36 cases (48.0%), and in 13 cases (17.3%) the diagnosis was uncertain. In patients with benign disorders the foci themselves were benign in 59 cases (95%), and in 3 cases (5%) the diagnosis was uncertain.
Conclusion: Echogenic splenic foci are rare. Distinguishing between benign and malignant foci based upon sonographic patterns alone is only possible in exceptional cases. Short term follow-up ultrasound examinations taking into consideration the patients' underlying disease lead to the correct diagnosis in most cases.