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A 41-year-old man presented at the emergency department with complaints of intolerable pain in the left upper quadrant. He had undergone extracorporeal shock wave lithotripsy (ESWL) eight hours prior as treatment for a left-sided kidney stone in the upper pole. Ultrasound demonstrated a large subcapsular hyperechoic collection in the spleen (Figure 1). A computerized tomography (CT) scan confirmed a laceration of the lower pole of the spleen with a subcapsular hematoma and a discrete amount of surrounding free fluid. Adjacent to the splenic laceration, a smaller subcapsular hematoma was also present in the left kidney (Figure 2). In the meantime, a fragmented stone in the proximal left ureter was visualized (1400 HU). The therapy was conservative with hemodynamic follow-up in the intensive care unit with normal patient recovery