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Introduction: Infectious mononucleosis, often caused by the Epstein Barr Virus, is a diagnosis that frequently occurs in the adolescent population. Following is a case description of an adolescent who presented with a non-traumatic splenic rupture after being diagnosed with infectious mononucleosis. The patient was ultimately treated with a splenic artery coil embolization.

Case Presentation: An adolescent female with flu-like symptoms and recently diagnosed EBV mononucleosis, presented with syncope, hypotension, tachycardia and acute abdominal pain. Physical examination revealed tachycardia, tachypnea, and significant abdominal guarding and tenderness. Ultrasound imaging showed free fluid in the abdomen, with CT demonstrating a splenic rupture and associated subcapsular hematoma. Subsequently, CT angiography was utilized to identify and embolize the splenic artery in a non-operative fashion, as well as identify collateral splenic arterial circulation. The patient remained hemodynamically stable during this time and tolerated the procedure well, with no other complications during the rest of the hospital course.

Discussion: Splenic rupture is a significant and dangerous complication of infectious mononucleosis. While the mechanism remains elusive, it is important for clinicians to be aware of this possible sequela and take necessary precautions for avoidance. The rupture is often caused by trauma, but can also be prompted in cases of increased intra-abdominal pressure or continued expansions of a subcapsular hematoma. As such, at-risk patients should avoid significant physical activity with close imaging follow-up. Hemodynamic stability is an important factor in determining the treatment for a splenic rupture, with possibilities including endovascular techniques versus splenectomy.

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