Unexpected Delayed Rupture of the Spleen That Initially Appeared Normal on Computed Tomography

A 47-year-old man had been a passenger in a traffic accident, and he was found outside the car when he was rescued. On arrival to our trauma center, although he was intoxicated, he had a Glasgow Coma Scale score of 15, was neurologically intact, and complained only of a headache. In the emergency room, computed tomographic (CT) scans of the brain, neck, chest (with contrast material), and abdomen and pelvis (with contrast material) were obtained. Imaging findings included an acute subdural hemorrhage with scalp laceration. No other acute findings were seen on the initial abdomenpelvis contrast-enhanced image. The official reading of the CT scan by the radiologist was also normal (Fig. 1.). The patient was admitted to general ward for nonoperative management. Four days after hospitalization, the patient’s hemoglobin level dropped abruptly from 17.0 to 9.9 g/dL. A second abdomen-pelvis CT scan with contrast material revealed a grade IV splenic rupture with hemoperitoneum (Fig. 2.). The patient was taken to the operating room for emergency explorative laparotomy, and splenectomy was performed (Fig. 3.). Eleven days after admission, the patient was discharged home.