Although splenic artery aneurysm is a relatively rare clinical entity, it is the second most common abdominal splanchnic artery aneurysm (SAAs), accounting for approximately 60% of all SAAs [1]. The pathogenesis of the splenic artery aneurysm appears unclear, but seems most likely due to degeneration of the vessel wall media from excessive splanchnic blood flow [1]. Asymptomatic splenic artery aneurysm rupture represents an uncommon cause of hypovolaemic shock in the emergency department (ED). Up to 25% of these aneurysms may be complicated by erosion or rupture, with a mortality ranging between 25 and 70% [1]. This aneurysm is often detected on imaging studies such as an ultrasound study or computed tomography (CT scan). Treatment can be either surgical or interventional radiology-based, and should be considered in all patients with symptoms related to the lesions [2]. In this paper, the management of a splenic artery aneurysm, discovered by an abdominal ultrasound study in an apparently healthy woman, is discussed. A 71-year-old woman was admitted to our medical ED, because of a month long abdominal pain occurring after meals, suggesting cholecystitis. She denied any history of hypertension, diabetes, cirrhosis, intestinal diseases or prior abdominal surgeries. The physical examination and laboratory tests were normal. In our case the abdominal symptoms are not specific for splenic artery aneurysm, because this latter commonly presents left upper quadrant or epigastric pain radiating to the left shoulder. There are non-correlations between size of the aneurysm and abdominal symptoms, confirming the evidence that these aneurysms are frequently asymptomatic and only incidentally discovered. However, their incidence is now more evident because of the availability of imaging. The patient underwent an abdominal ultrasound examination that showed a large hypoechogenic mass of 2.5 cm of diameter in the left side of the abdomen (near the splenic hilum region); no gall stones were found during this examination. The colour Doppler study showed the presence of blood flow suggesting a possible splenic artery aneurysm. Computed tomography (CT) angiography showed a voluminous saccular dilatation of the splenic artery in the middle tract (Fig. 1a). It is recommended that an asymptomatic aneurysm larger than 3 cm is an indication for surgery, while those between 1 and 2 cm in diameter should be monitored closely with imaging studies every 6 months or so, avoiding hospital admission. However, mortality after emergency surgery is as high as 40%, compared with a negligible mortality after elective management [3]. A selective catheterisation of the splenic artery by a 4-F-SIM-1 catheter (Cordis Europa, Roden, Olanda) led to the embolisation of the aneurysm using metallic coils (IMWCE), coaxially inserted both upstream and downstream of the aneurysm. A. Mazza D. Montemurro S. Zamboni Department of Internal Medicine, Rovigo General Hospital, Rovigo, Italy