A strong clinical assessment with a focused history, a mechanism of injury, and physical exam may provide a high index of suspicion for diagnosis, but a ruptured spleen can’t always be ruled out from just a clinical assessment. Ultrasound is an option but still cannot rule out a ruptured spleen adequately.
If available, a CT scan is the best option for evaluating the abdomen and diagnosing a ruptured spleen in a clinically stable patient. CT scans can detect as little as 100 cubic centimeters of blood in the abdomen, an amount similar to about one-third of a can of soda.