Abstract: Splenic epidermoid cyst is a rare entity and rarely becomes complicated by hemorrhage. We present a case of splenic epidermoid cyst with old hemorrhage showing strong FDG uptake in the cyst wall. Histopathology revealed granulation tissue with abundant inflammatory cells, including many hemosiderin-laden macrophages, in the inner layer of the cyst wall. The abundant inflammatory cells in the granulation tissue may contribute to the strong FDG uptake of the cyst wall. This case highlights that a benign lesion with hemorrhage should be included in the differential diagnosis of abnormal splenic FDG uptake along with tumor and inflammatory processes.