This 26 y/o male presented to the emergency room with severe abdominal pain localized to the left lower quadrant of the abdomen of four hours duration. He denied nausea, vomiting, diarrhea, dysuria, fever, chills, Hx of ulcers or recent trauma. He stated that about a week ago he had a "cold" with sore throat and stuffy nose, which he had treated with over the counter remedies. On physical exam a rigid abdomen was found, with rebound, and greater tenderness in the lower abdomen. The surgeon who evaluated the patient requested a CT scan of the abdomen and pelvis. The patient refused the administration of IV contrast as he was "afraid of needles", despite multiple tatoos on his body. The non contrast CT showed fluid/blood in the abdomen & pelvis as depicted above. The patient was taken to surgery and a spontaneously ruptured spleen was removed. Subsequent workup revealed antibody studies positive for mononucleosis.