Littoral cell angioma (LCA) is an extremely rare primary splenic tumor. There are few MRI and scintigraphic characteristics described. These characteristics may be most helpful in differentiating LCA from other primary vascular tumors. We present a 54-year-old woman found on CT to have a 7-cm mass within an enlarged spleen. LCA was diagnosed by ultrasound (US)-guided biopsy. She was successfully treated with laparoscopic splenectomy. The CT, MRI, US, and Tc99m-RBC scan characteristics are described along with histologic and immunohistochemical correlation.