Occasional normal anatomic variations may produce radiographic appearances that closely simulate disease and visceral enlargement may cause unusual displacements of adjacent organs. Two cases are reported in whom prominent splenic lobulation caused flattening of the upper pole of the left kidney. The appearance simulated that produced by a supra-renal mass. The value of CT in differentiating this normal variation from disease is discussed. A third patient in whom massive splenomegaly caused upward displacement of the left kidney is also reported. The literature concerning visceral relationships in the left upper quadrant and the normal variations that simulate disease is reviewed.