PMC9035913_01
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.
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F1
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).
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.
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F2
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).
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.
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F3
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).