case_images: PMC9035913_01
case_images: CT A/P with contrast on admission demonstrating marked splenomegaly, an ill-defined 5 x 6 cm mass within the spleen (of mixed densities some or all of which may be hemorrhagic), and moderate volume-free fluid in the pelvis, small perisplenic, and trace perihepatic.
case_images: cro-0015-0277-g01.jpg
case_images: PMC9035913_01_cro-0015-0277-g01.jpg
case_images: F1
case_images: A CT scan demonstrated marked splenomegaly (25 cm in greatest dimension) with a 5 x 6 cm mass of mixed densities suggestive of a hemorrhagic lesion with associated splenic capsular disruption and moderate volume free fluid in the pelvic, perisplenic, and perihepatic regions concerning for hemoperitoneum (shown in Fig. 1).
case_images: Pertinent laboratories during hospitalization. Splenic embolization was performed on day of admission. Rasburicase/allopurinol was administered on hospital day 5, and hydroxyurea was administered on day 6.
case_images: cro-0015-0277-g02.jpg
case_images: PMC9035913_01_cro-0015-0277-g02.jpg
case_images: F2
case_images: His WBC rose to a peak of 118,000/muL (1-2% blasts), for which hydroxyurea was initiated, and his platelets increased to 100,000/muL (shown in Fig. 2). He received one dose of rasburicase and started allopurinol (shown in Fig. 2).
case_images: CT A/P with contrast at 1-month follow-up demonstrating post-embolization liquefaction, overall splenic size is slightly decreased since the previous CT, measuring up to 22 cm craniocaudal versus 24 cm previously. Now large cystic component measuring 22 x 13 x 21 cm, likely relating to post embolization liquefaction. No significant perisplenic inflammatory fat stranding to suggest superimposed infection.
case_images: cro-0015-0277-g03.jpg
case_images: PMC9035913_01_cro-0015-0277-g03.jpg
case_images: F3
case_images: Imaging post-discharge demonstrated a decreased splenic size, with a large cystic component measuring 22 x 13 x 21 cm, likely related to post-embolization liquefaction (shown in Fig. 3).