Littoral cell angioma is a rare primary vascular tumour of the spleen arising from littoral cells lining the venous sinuses of the red pulp. It is exceptionally uncommon in children and may be difficult to distinguish preoperatively from other benign or malignant splenic lesions. The article presents the case of an 8-year-old boy in whom a cystic splenic lesion was detected incidentally during abdominal ultrasound. Due to the uncertain nature of the lesion, the patient remained under clinical and imaging surveillance for more than two years. Eventually, laparoscopic hemisplenectomy was performed. Histopathological examination established the final diagnosis of littoral cell angioma. This case highlights the diagnostic difficulty of paediatric splenic lesions and the role of surgical treatment in achieving definitive diagnosis and management.