Primary tumors of the spleen are rarely encountered in clinical practice and their diagnosis often requires invasive procedures (splenectomy). Leiomyosarcomas are rare tumors originating from smooth muscle cells or their precursor mesenchymal cells and as such can arise in any organs, most typically abdominal ones. Only a few cases of leiomyosarcomas of the spleen have been described in literature. We present the case of a 69 year-old, a previously healthy patient, with non-specific symptoms, diagnosed on CT scan with multiple splenic, hepatic and bone tumors. Biopsy from one of the liver tumors revealed the diagnosis of leiomyosarcoma. Due to characteristic aspects on contrast-enhanced ultrasonography and CT scan we concluded that the primary tumor was located in the spleen, while the others represented metastases.