To investigate the CT manifestations and differential diagnosis of primary vascular tumors of the spleen.

Between December 1989 and November 2018, CT images and clinical data from fifty-nine cases with primary vascular tumors of the spleen confirmed by histopathology and relevant literatures were reviewed.

There were three enhancement modes for splenic hemangioma after contrast-enhanced CT scan, while lymphangioma had no enhancement in 6 cases. Hamartoma was similar to hemangioma in 6 cases. 17 hemangio-lymphangioma manifested differently according to the proportion of lymphatic vessels and blood vessels. Littoral cell angioma appeared as multiple low-density nodules in the spleen, with progressive enhancement or mild enhancement in 8 cases. Angiosarcoma was characterized by heterogeneous enhancement, necrosis and/or abnormal blood vessels in the tumor, often accompanied by metastasis in 2 cases.

Although the imaging manifestations of primary splenic vascular tumors have different characteristics, some of them overlap with each other. CT examination is helpful for the diagnosis and differentiation of primary splenic vascular tumors.