# Beyond trauma: a case-based imaging review of spontaneous splenic rupture

## TL;DR

This paper presents a case of spontaneous splenic rupture in an elderly woman and discusses the role of imaging in diagnosis and management.

## Contribution

The paper highlights a rare case of SSR due to a splenic hamartoma and reviews updated imaging strategies including radiomics and AI.

## Key findings

- Imaging, especially CECT, is crucial for diagnosing splenic injury and identifying underlying lesions.
- Non-operative management was initially successful, but elective splenectomy was performed due to a structural lesion.
- Radiomics and AI are emerging tools in improving diagnostic accuracy for splenic rupture.

## Abstract

Spontaneous splenic rupture (SSR) is a rare but potentially life-threatening condition, most commonly associated with underlying infectious, haematological, vascular, or neoplastic processes. Clinical presentation is often non-specific, which may lead to delayed diagnosis. Imaging, particularly contrast-enhanced computed tomography (CECT), plays a pivotal role in confirming splenic injury, identifying predisposing lesions, and guiding management. We present the case of a woman aged in her seventies with chronic atrial fibrillation on antiplatelet therapy who developed spontaneous splenic rupture secondary to an occult splenic hamartoma. Ultrasound demonstrated heterogeneous perisplenic fluid and altered splenic echotexture. CT showed a 3.5 cm laceration, moderate haemoperitoneum, and a solid lesion with delayed enhancement and no active bleeding. Follow-up CT revealed progressive organisation of haemoperitoneum and stable lesion morphology. The patient was initially managed non-operatively due to haemodynamic stability, but elective splenectomy was performed given the presence of a structural lesion and the need for chronic anticoagulation. The purpose of this article is to illustrate the diagnostic and management principles of SSR through a representative clinical case and to provide an updated review of imaging strategies, including emerging applications of radiomics and artificial intelligence (AI).