The work presents the analysis of ultrasound diagnostic of traumatic hematomas of the spleen in 12 patients after blunt abdominal trauma. Traumatic injuries of large (4 patients) and giant (5 patients) sizes prevailed. Only 3 patients had medium sized traumatic lesion. Ultrasound examination was performed for all patients as a primary procedure and for dynamic observation. We tracked evolution of traumatic spleen injuries and identified four stages of pathological process in case of aseptic development: the stage of “fresh hemorrhage”, the stage of “formed clot”, the stage of “aseptic lysis of the clot”, the stage of “connective tissue organization”. We determined the evidence of pyogenesis of spleen hematomas, identified the stage “bacterial lysis of the clot” and stage of “forming capsules”. We determined the indications and contraindications for the minimally invasive treatment of spleen hematoma. Percutaneous evacuation of the spleen hematoma was performed in all patients. In four cases of minimally invasive treatment was puncture. In one patient the treatment was completed with a single puncture, in 3 patients – with a double one. Drainage of spleen hematomas was performed in 8 patients. We analyzed the results of minimally invasive treatment of traumatic injuries of the spleen under ultrasound control. Minimally invasive treatment was successful in 11 patients. Only 1 patient was operated for post-traumatic aneurysm of the splenic artery due to the continuing bleeding into hematoma.