Background: Splenic haematomas are common and often traumatic in nature, though they can occur spontaneously. Management can be conservative or surgical. Radiologically they can appear similar to splenic tumours. Splenic tumours are rare and can be very aggressive in nature.
Case Report: We describe a case of a 68yr old man presenting with left upper quadrant pain who was thought to have a pulmonary embolus. A spontaneous splenic haematoma was identified on his CT scan. Laparotomy revealed a primary splenic tumour infiltrating local structures and a macroscopic resection was performed. Histology revealed a possible spindle cell tumour, inflammatory myofibroblastic tumour or mesothelioma of unclear aetiology. Extensive metastases were identified 3 months following surgery. The patient represented 4 months following surgery with sepsis due to a colonic fistula and the patient died.
Conclusions: Caution must be taken when diagnosing a splenic haematoma in the abscenc of trauma. Splenic tumours can be highly aggressive and incurable. Histological classification of the tumour may not always be possible.

Keywords: Splenectomy, Abdominal Neoplasms - surgery, inflammatory myofibroblastic tumour