splenic metastasis of lung tumors is rare . in a recent study , splenic metastatic disease from primary lung cancer one current hypothesis explaining the rarity of splenic metastasis in lung cancer is the filtration function of the spleen . the spleen , being the source of many pro - apoptotic factors that help to destroy aged granulocytes , may also help to destroy cancer cells that pass through the spleen . this case presents a patient with non - traumatic splenic rupture as the initial presentation of lung cancer metastasis . a 61-year - old male presented with a 2-week history of worsening posterior neck and bilateral shoulder pain , and a several hour history of severe , left - sided abdominal tenderness . the patient had been diagnosed with poorly differentiated , left lung adenocarcinoma 5 months prior ; he was status - post left upper lobectomy . pet scan , at that time ( fig .  1 ) , showed no evidence of metastatic disease and the pathologic staging was determined to be t2an0m0 ( stage 1b ) . pet ct showing left lingular malignancy and no evidence of metastasis . in the emergency department on current presentation , the patient was hypotensive with a blood pressure of 76/40 . physical examination revealed a soft , distended abdomen that was tender in the left upper quadrant . ct scan of the chest , abdomen and pelvis revealed hemoperitoneum and a possible splenic laceration ( fig .  2 ) . the resected specimens all revealed metastatic , poorly differentiated non - small - cell carcinoma ; consistent on immunoperoxide staining with the previously known primary lung cancer diagnosed and treated 4 months prior . further workup on this patient revealed a final diagnosis of stage iv non - small - cell lung cancer with metastases to the liver , mesentery , spleen and cervical spine . the patient was started on radiation therapy , but eventually refused more treatment due to the pain he was experiencing . the initial presentation of lung cancer metastasis as a splenic rupture is a very rare event . review of literature shows only seven cases of spontaneous splenic rupture due to metastatic lung cancer [ 2 , 3 ] . this appears to be the first case in literature in which disseminated metastatic adenocarcinoma of the lung presented with spontaneous splenic rupture . previous cases of splenic rupture were seen as an occult presentation of lung cancer   and as a solitary metastatic lesion . autopsy studies have shown splenic metastases to be present in 2.37.1% of patients with cancer . autopsy studies have also shown melanoma of the skin to be the most common cancer to metastasize to the spleen . a 25-year uni - institutional study of splenic metastasis showed that only 7 of 92 patients with splenic metastasis were symptomatic . of these seven , only two cases involved a rupture of the spleen , yielding a splenic rupture rate due to metastasis of only 2.17% . this same study showed that the splenic metastases where found 15 months to 2 years after the discovery of the primary tumor . the patient in this case presented with splenic rupture only 5 months after the initial diagnosis of lung cancer and 4 months after surgical resection . splenic metastasis of lung cancer is a rare phenomenon , which is usually asymptomatic . in patients with history of lung cancer presenting with splenic rupture and no history of trauma
splenic metastasis of solid organ tumors is rare ; even more so is splenic rupture from metastatic disease . 
 we report a case of a 61-year - old male who presented with splenic rupture and hemodynamic instability , secondary to malignant metastasis from a recently diagnosed left lung cancer .