Splenosis is an acquired condition characterized by heterotopic autotransplantation of splenic tissue following splenic trauma or splenectomy and may mimic intra-abdominal neoplastic lesions on imaging. We report the case of a 38-year-old female patient with a history of splenectomy who presented with right upper quadrant abdominal pain. Multimodality imaging revealed a solitary well-defined lesion in the splenic fossa demonstrating imaging characteristics comparable to native splenic tissue on ultrasonography, shear-wave elastography, and magnetic resonance imaging (MRI). Shear-wave elastography demonstrated homogeneous stiffness values, while MRI showed signal intensity and diffusion characteristics similar to those of splenic tissue, without aggressive imaging features. In the absence of histopathological or scintigraphic confirmation, the diagnosis strongly favored splenosis based on the characteristic imaging findings and clinical correlation. This case highlights the importance of recognizing the multimodality imaging appearance of splenosis to avoid unnecessary invasive diagnostic or surgical procedures.
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