The availability of ultrasonography and computerized tomography has significantly improved diagnostic capability in the evaluation of splenic abscess. In addition, recent evidence has shown that percutaneous drainage of splenic abscess is a safe and efficacious approach to therapy and is indicated especially when patients are seriously ill, postoperative or when the risks of general anesthesia, surgical drainage or splenectomy are substantial. Adequacy of response to percutaneous drainage correlates positively with the presence of unilocular collections that have a discrete wall without internal septations. In contrast, multiloculated or complex pyogenic splenic abscesses should usually be treated using operative intervention. Discussion of important features of this illness, as well as a comprehensive review of reported instances and guidelines related to percutaneous drainage of splenic abscess, are presented herein. A team approach, which uses the experience of imaging and surgical personnel, is invaluable in therapy when a splenic abscess is encountered.