CT of spontaneous atraumatic splenic rupture: etiologies and imaging findings

Spontaneous or atraumatic rupture of the spleen is an uncommon but potentially fatal abdominal emergency, often overshadowed by trauma-related etiologies. However, a wide range of infectious, neoplastic, vascular, autoimmune, and iatrogenic conditions can predispose the spleen to rupture without direct trauma. Multidetector computed tomography (MDCT) is the preferred modality for evaluating these cases, offering rapid, high-resolution assessment of hemorrhage-with or without active bleeding-and associated parenchymal abnormalities. This pictorial review highlights the diverse spectrum of underlying causes and characteristic imaging findings through 13 cases. It also outlines CT acquisition protocols, postprocessing techniques, and key clinical features that radiologists must be aware of to reach timely diagnoses and guide management. Early recognition and identification of the underlying pathology are critical in improving patient outcomes and directing appropriate interventions.