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

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).