Sarcoidosis is a multisystem granulomatous disease of unknown cause that commonly involves the spleen. Sarcoid can produce either homogeneous splenomegaly or multiple splenic nodules. Although other organ system involvement usually occurs, this is not invariable. Herein, we report on the clinical, histological, and radiological featuresincluding sonography and MRIof an isolated splenic sarcoidosis that mimicked neoplastic disease in a 37-year-old female. Knowledge of this atypical sonographic presentation may prevent unnecessary splenectomy. (c) 2013 Wiley Periodicals, Inc. J Clin Ultrasound42:38-41, 2014