Spontaneous splenic rupture

Spontaneous splenic rupture (SSR) (also known as atraumatic splenic rupture) is rare, especially when compared to traumatic splenic rupture. 

Pathology

The pathogenesis of atraumatic splenic rupture is not well understood. Splenomegaly is present in almost all patients (~95%), although the rupture of normal spleens (both in size and underlying histology) has been reported ³. 

Etiology

There is a wide range of underlying causes ^1,2:

• hematological malignancies, e.g. lymphoma, leukemia (~15%)
• infections (~15%)
  • viral, e.g. infectious mononucleosis, cytomegalovirus
  • bacterial, e.g. infective endocarditis, tuberculosis
  • parasitic, e.g. malaria
• local inflammatory disorders, e.g. pancreatitis (~10%)
• infectious mononucleosis (less than .5%) ⁷
• non-malignant hematological disorders, e.g. Langerhans cell histiocytosis
• primary splenic neoplasms, e.g. angiosarcoma, hemangioma
• amyloidosis (primary and secondary)
• post-colonoscopy ⁴
• sneezing ⁵
• sarcoidosis ⁶

Radiographic features

Features are similar to splenic trauma with hemoperitoneum and perisplenic hematoma. The spleen is more likely to be enlarged in atraumatic ruptures ³.