Ultrasound detection of spontaneous rupture of accessory spleen: A case report

Abstract

Accessory spleen rupture can induce acute abdominal bleeding following minimal trauma or by atraumatic mechanisms. Spleen rupture is more frequent in pediatric patients and those affected by hematological diseases. We described the case of a 59-year-old male patient affected by hereditary spherocytosis referred to the emergency department for abdominal left side pain. An early ultrasound performed in the emergency department allowed to diagnosed hemoperitoneum by spontaneous bleeding of hypertrophic accessory spleen. Although abdomen computed tomography is the diagnostic method of choice, ultrasound can early detect sign of emoperitoneum in the emergency setting in case of hemodinamically unstable patient.

Keywords: Emergency; POCUS; Pain; Spleen; Ultrasound.

Fig. 1

B mode ultrasound showed a rounded echogenic formation with subcapsular inhomogeneity and anechoic layer around it. This finding was suggestive for hypertrophic accessory spleen (1) with subcapsular hematoma (2) and hemoperitoneum (3).

Fig. 2

Abdomen CT without and with contrast medium showing hypertrophic accessory spleen with an axial diameter of 55 mm with peripheral collection sparing the hilum region identifiable in the posterolateral area. That collection is more relevant on the upper pole, it is spontaneously hyperdense and supplied by an arterial spot from active bleeding on the antero-superior face of the organ. Moreover, an intraperitoneal hemorrhagic diffusion in the perisplenic adipose tissue was evident, which collects in the right perihepatic recesses, in Morrison's space, in the right parieto-colic shower, and in the pelvis.