The purpose of this article is to evaluate the role of contrast-enhanced ultrasound in the characterization of non-traumatic focal splenic lesions. Focal splenic lesions are less common than in other abdominal organs like the liver. Conventional ultrasound and Doppler ultrasound have a limited role in the characterization of splenic lesions, resulting in many of them unspecified. Contrast ultrasound is an accessible, cheap, and safe technique which can help in the immediate characterization of lesions incidentally detected in the ultrasound examination, being a good alternative to others imaging techniques. We review in detail the technique and the main indications. We also analyze imaging findings and enhancement pattern by using representative case of the main splenic lesions for both benign (epithelial cyst, cystic lymphangioma, hemangioma, hamartoma, infarction, sclerosing angiomatous nodular transformation, abscesses, sarcoidosis), and malignant (lymphoma, metastasis) and its pathological correlation in some cases.