Which disease process may cause numerous shadowing calcifications to form within the spleen?

Histoplasmosis is a fungal infection that can lead to granulomatous disease. Chronic granulomatous infections may result in multiple splenic calcifications that appear as small echogenic foci with shadowing on ultrasound. Other infectious granulomas (e.g., tuberculosis) may present similarly.

According to Rumack's Diagnostic Ultrasound:

“Granulomatous infections such as histoplasmosis and tuberculosis may produce multiple splenic calcifications, often with shadowing.”