Presentation
Left flank pain with symptoms of left diaphragmatic irritation. No history of trauma. Referred massage one day ago.
Patient Data
Large splenic subcapsular hematoma with contrast blush foci inferring active bleeding. Hypoenhancing areas of the splenic parenchyma are mostly superficial and with less than 3 cm in depth; splenic vascular hilum appears preserved. Free intraperitoneal fluid is of hematic content. The liver, pancreas, and adrenal glands are unremarkable. Bilateral renal cysts demonstrated, with no suspicious enhancement. No evidence of renal calculi. No abnormality of the bowel is identified. No free gas. No lymph node enlargement. No fractures or suspicious bone lesions.
Proximal splenic embolization performed with 6, 5 and 4 mm Interlock detachable microcoils to stasis.
Treatment images courtesy of the Royal Melbourne Hospital Interventional Radiology team.
Case Discussion
This case illustrates a splenic rupture of unknown cause, presumed atraumatic. The patient has mentioned a history of massage one day ago but referred it was a more relaxing and not strong message. No evidence of splenomegaly or other underlying condition to explain the spontaneous rupture.
The patient was considered with a borderline hemodynamic instability, and a splenic artery embolization was proposed as the treatment.
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