Objective: Ultrasound contrast agents in conjunction with contrast specific imaging techniques, are increasingly accepted in clinical use for diagnostic imaging in several organs. Contrast enhanced sonography (CES) of second generation contrast media have shown a spleen-specific uptake of the microbubble contrast agent. The aim of this review is to illustrate indications for the use of CES in patients with suspected (peri-)splenic pathology. Methods: This pictorial review based on the experience of transcutaneous CES in 180 consecutive adult patients with (peri-)splenic pathology diagnosed by B-mode sonography at an internal medicine center. CES studies were performed with a contrast-devoted unit (Acuson, Sequoia, Siemens medical solution) that had contrast-specific, continuous-mode software. A low mechanical index was used. A sulfur hexafluoride-based microbubble contrast medium (Sonovue®, Bracco SpA, Milan, Italy) was injected. Results: On our experience there are six clinical conditions which indicates the use of CES for diagnosis of (peri-)splenic pathology: 1. the perisplenic tumor, 2. the small sized spleen, 3. the inhomogenous spleen of unknown cause, 4. the incidentally found hypoechoic splenic tumor, and 5. pain in the left upper quadrant, and 6. patients with blunt abdominal trauma. CES is of value 1. to diagnose or exclude accessory spleen, 2. to diagnose functional asplenia/hyposplenia, 3. to diagnose focal lesions in an inhomogenous spleen, 4. to diagnose high vascular splenic hemangioma, 5. to diagnose or exclude splenic infarction and splenic abscess, and 6. to diagnose splenic laceration. Conclusion: CES is of diagnostic value in several clinical circumstances to diagnose accessory spleen, functional asplenia, small sized splenic involvement, high vascular splenic hemangioma, and vascular splenic pathology like splenic infarction, splenic abscess, and splenic laceration.