We report the case of a patient presenting an acute fissuration of a previously asymptomatic giant splenic artery aneurysm detected by POCUS. Thanks to early detection, the aneurysm was embolized before full rupture and the patient was discharged home without complication. The occurrence of fissuration allowed an effective treatment before a catastrophic hemorrhagic shock. Although POCUS was used in other similar cases with SAA, the ultrasound was not conclusive and the diagnosis was made by CT-scan [
2,
7]. To our knowledge, detection by POCUS of a fissuration episode has not been published. The “detection” of the SAA was done by POCUS in the case of Lo and Mok published in this journal [
2], but the suspicion was of abdominal aortic aneurysm, so even if they detected it by POCUS, the correct and final diagnosis was made by CT-scan. There are many other similar cases [
8] described in the literature, where POCUS showed an anechoic mass that sometimes was confused with a pancreatic cyst and others with an aortic aneurysm, and CT-scan was needed to reach the correct diagnosis [
7,
9]. Rupture occurs in approximately 10% of SAA, especially when diameter exceeds 2 cm [
10], with a mortality rate of 10–25% [
2]. Even if incidence and rupture rates are particularly increased in the third trimester of pregnancy [
10], the risk is higher from the first trimester [
11]. In all patients, endovascular embolization should be considered as the first-line treatment [
3,
12] rather than surgery, but strong evidence is still lacking.
Abdominal pain accounted for 8 million ED visits in USA in 2006 [
1]. Epigastric pain remains a challenging situation in particular in older patients. A pragmatic pathway could include a thorough physical exam, an ECG, appropriate biological workup, and POCUS.