Fig. 1
From: Atraumatic splenic rupture, an underrated cause of acute abdomen
A 75-year-old male presented to emergency department with generalised acute abdominal pain and physical signs of haemodynamic impairment. His past medical history included coronary stenting and endovascular treatment of aneurysmal dilatation of the thoracic aorta, respectively, 13 and 5 years earlier. He denied trauma and unusual efforts, and was on regular warfarin anticoagulation. Bedside ultrasound (not shown) revealed echogenic peritoneal effusion. Emergency multidetector CT including unenhanced (a), arterial- (b, c), and portal venous (D) post-contrast acquisitions showed a normal-sized spleen, compressed by the extensive perisplenic haemorrhage (*). Contrast extravasation isoattenuating with enhanced blood vessels (arrows in B…D) and increasing from the arterial to the venous acquisition was noted at the upper splenic pole, indicating non-contained active bleeding. Multi-compartmental haemoperitoneum (+) was present. Note the metallic endoprosthesis of the distal thoracic descending aorta. Immediate splenectomy confirmed bleeding from a polar laceration. Gross and microscopic pathology did not disclose underlying abnormalities