[Traumatic splenic injury with unexpected rupture of an echinococcal cyst : A very rare differential diagnosis in the emergency room].

We report a rare case of traumatic splenic rupture with concomitant rupture of an intraparenchymal echinococcal cyst in a 48-year-old male patient following a fall from a ladder from a height of approximately 3 m. The initial advance trauma life support (ATLS)-based emergency room diagnostics revealed perisplenic free fluid on ultrasound examination as well as an atypical, partially calcified lesion within the splenic parenchyma. Contrast-enhanced computed tomography (CT) demonstrated a high-grade splenic laceration with massive intra-abdominal hemorrhage and a ruptured, calcified cyst located at the inferior splenic pole with a volume of approximately 265 ml. Despite initially stable hemodynamic parameters, immediate surgical intervention was indicated due to the extent of the injury. The CT findings were confirmed intraoperatively and splenectomy with abdominal lavage was performed. Histopathological examination verified a ruptured intraparenchymal echinococcal cyst. Postoperatively, antiparasitic treatment with albendazole was initiated and standard postsplenectomy vaccination was administered. The patient was discharged after 8 days. This case highlights that even in nonendemic regions, rare parasitic diseases should be considered in the differential diagnosis of splenic injuries with atypical cystic or calcified findings. In acute trauma settings, therapeutic decision-making should be guided not only by the hemodynamic status but also by the overall extent of injury.