Case Report: A 57-year-old female patient with granulomatosis with polyangiitis presenting with unexplained elevated liver enzymes (no abdominal symptoms). Ultrasound reveals surprising spleen pathology: the spleen appears largely fluid-filled, with only a small amount of solid tissue; the spleen capsule is intact. Contrast-enhanced ultrasound shows little preserved and contrast enhanced splenic parenchyma, with no contrast leakage into the liquid areas. No history of any trauma. The findings are consistent with a  rare case of a asymptomatic subtotal splenic necrosis, most likely in the context of a necrotizing vasculitis.