Splenic artery aneurysm: Difference between revisions
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*Incidence on CT = 0.8%<ref name="khosa">Khosa, Faisal, MD. "Managing Incidental Findings on Abdominal and Pelvic CT and MRI, Part 2: White Paper of the ACR Incidental Findings Committee II on Vascular Findings." Journal of the American College of Radiology 10.10 (2013): 789-94.</ref>
*Incidence on CT = 0.8%<ref name="khosa">Khosa, Faisal, MD. "Managing Incidental Findings on Abdominal and Pelvic CT and MRI, Part 2: White Paper of the ACR Incidental Findings Committee II on Vascular Findings." Journal of the American College of Radiology 10.10 (2013): 789-94.</ref>
*Female:Male 4:1
*Female:Male 4:1
*2% result in life-threatening rupture
*Increase risk of rupture in pregnancy (most commonly in 3rd trimester).  <ref>Parrish J, Maxwell C, Beecroft J. Splenic Artery Aneurysm in Pregnancy. JOGC. 2015; 37(9):816–818.</ref>
*Increase risk of rupture in pregnancy (most commonly in 3rd trimester).  <ref>Parrish J, Maxwell C, Beecroft J. Splenic Artery Aneurysm in Pregnancy. JOGC. 2015; 37(9):816–818.</ref>
**Thought to be secondary to increase in estrogen, progesterone and relaxin causing aneurysmal dilatation.  
**Thought to be secondary to increase in estrogen, progesterone and relaxin causing aneurysmal dilatation.  
**High maternal and fetal mortality post-ruputre
**High maternal and fetal mortality post-rupture


==Clinical Features==
==Clinical Features==
*Typically asymptomatic (most are incidental CT finding)
*Typically asymptomatic or vague with [[left upper quadrant pain]] with radiation to the left shoulder or subscapular area (most are incidental CT finding)
*May have epigastric/abdominal pain and/or hemodynamic instability if ruptured
*May have epigastric/abdominal pain and/or hemodynamic instability if ruptured


==Differential Diagnosis==
==Differential Diagnosis==
*Calcified left adrenal haematoma
*Calcified left adrenal haematoma
*Other causes of hemoparitoneum if ruptured
*Other causes of hemoperitoneum if ruptured
**Ruptured ectopic pregnancy
**Ruptured [[ectopic pregnancy]]


==Evaluation==
==Evaluation==
*CTA Abdomen/Plevis is the gold standard<ref>Casadei R. et al. Thrombosed splenic artery aneurysm simulating a pancreatic body mass: can two entities be distinguished preoperatively thus avoiding diagnostic and therapeutic mistakes? JOP 2007;8:235–9</ref>
*CTA Abdomen/Pelvis is the gold standard<ref>Casadei R. et al. Thrombosed splenic artery aneurysm simulating a pancreatic body mass: can two entities be distinguished preoperatively thus avoiding diagnostic and therapeutic mistakes? JOP 2007;8:235–9</ref>
*Initial [[FAST exam]] may show fluid in left upper quadrant if ruptured aneurysm
*Initial [[FAST exam]] may show fluid in left upper quadrant if ruptured aneurysm


Latest revision as of 00:16, 30 September 2019

Background

  • The most common visceral arterial aneurysm, and the third most common abdominal aneurysm (after aorta and iliac vessels)
  • Etiologies include arterial fibrodysplasia, portal hypertension, and increased splenic AV shunting in pregnancy
  • Incidence on CT = 0.8%[1]
  • Female:Male 4:1
  • 2% result in life-threatening rupture
  • Increase risk of rupture in pregnancy (most commonly in 3rd trimester). [2]
    • Thought to be secondary to increase in estrogen, progesterone and relaxin causing aneurysmal dilatation.
    • High maternal and fetal mortality post-rupture

Clinical Features

  • Typically asymptomatic or vague with left upper quadrant pain with radiation to the left shoulder or subscapular area (most are incidental CT finding)
  • May have epigastric/abdominal pain and/or hemodynamic instability if ruptured

Differential Diagnosis

  • Calcified left adrenal haematoma
  • Other causes of hemoperitoneum if ruptured

Evaluation

  • CTA Abdomen/Pelvis is the gold standard[3]
  • Initial FAST exam may show fluid in left upper quadrant if ruptured aneurysm

Management

  • Surgery and/or IR consult
  • Ruptured aneurysm requires emergent laparotomy or endovascular intervention

Disposition

  • Discharge:
    • Aneurysm size <2cm, asymptomatic, and hemodynamically stable
    • Follow-up with PCP and/or vascular surgery for surveillance scans at 6 months and then every 1-2 years.
  • Admit:
  • Aneurysm of any size in symptomatic patients, cirrhotic patients undergoing liver transplant, patients with α-1 antitrypsin deficiency, and patients who are pregnant or of childbearing age (requires consultation with a vascular surgeon for ligation or embolization)
  • Aneurysm size >2cm (Requires consult with a vascular surgeon for ligation or embolization)[4]

See Also

External Links

References

  1. ↑ Khosa, Faisal, MD. "Managing Incidental Findings on Abdominal and Pelvic CT and MRI, Part 2: White Paper of the ACR Incidental Findings Committee II on Vascular Findings." Journal of the American College of Radiology 10.10 (2013): 789-94.
  2. ↑ Parrish J, Maxwell C, Beecroft J. Splenic Artery Aneurysm in Pregnancy. JOGC. 2015; 37(9):816–818.
  3. ↑ Casadei R. et al. Thrombosed splenic artery aneurysm simulating a pancreatic body mass: can two entities be distinguished preoperatively thus avoiding diagnostic and therapeutic mistakes? JOP 2007;8:235–9
  4. ↑ Lakin, Ryan O., MD. "The Contemporary Management of Splenic Artery Aneurysms." Journal of Vascular Surgery 53.4 (2011): 1157.
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