Splenic pathologies: A pictorial review of common, wandering, twisting and rare presentations

Splenic pathologies, often overlooked in abdominal imaging, encompass a broad spectrum of imaging appearances and diagnostic challenges, including congenital anomalies, benign cysts, infarcts, trauma, vascular lesions, infections and neoplasms. Recognising these entities is crucial to distinguish incidental benign findings from potentially life-threatening conditions. This pictorial review illustrates the spectrum through 20 cases, including a rare case of a wandering spleen complicated by torsion and auto-infarction that demonstrates the classical 'whorled pedicle' and 'twisted vascular pedicle' signs. Ultrasound, CT, MRI and PET-CT images demonstrate typical and atypical features, emphasising key differentiating points and teaching pearls. Although not exhaustive, this overview underscores that closer scrutiny of the spleen is rewarding: a structured approach focusing on lesion location, enhancement patterns and clinical context improves diagnostic accuracy and guides timely management.