Tennessee Medicine E-Journal


Atraumatic spontaneous splenic rupture is rare and occurs in the setting of spleen pathology from a myriad of causes, including myeloproliferative disorders. Only four previously reported cases of atraumatic spontaneous splenic rupture associated with polycythemia vera exist. We report the fifth case, which also is the first with severe thrombocytosis requiring multiple plateletpheresis despite medical therapy and excellent long-term control. In addition to reporting the fifth case of spontaneous splenic rupture in a polycythemia vera patient, we also review the risks associated with splenectomy in patients with polycythemia vera and therapies that can prevent spontaneous splenic rupture.

PV_CT.jpg (144 kB)
Figure 1. CT abdomen/pelvis without contrast. The spleen is enlarged measuring 20 by 8 cm in the axial plane and 22 cm in craniocaudal dimension in coronal reconstructed images. There is extensive fluid scratched at there is fluid around the spleen and a large hypodense focus suggesting rupture. There is fluid around the anterior and right side of the liver as well as both pericolic gutters.