Splenic artery aneurysm: Difference between revisions
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==Background== | ==Background== | ||
*The most common visceral arterial aneurysm, and the third most common abdominal aneurysm after | *The most common visceral arterial aneurysm, and the third most common abdominal aneurysm (after aorta and iliac vessels) | ||
* | *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 | ||
*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-ruputre | ||
==Clinical Features== | |||
*Typically asymptomatic (most are incidental CT finding) | |||
*May have epigastric/abdominal pain and/or hemodynamic instability if ruptured | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==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> | |||
*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 | ||
==Management== | ==Management== | ||
* | *Surgery and/or IR consult | ||
*Ruptured aneurysm requires emergent laparotomy or endovascular intervention | |||
==Disposition== | ==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)<ref>Lakin, Ryan O., MD. "The Contemporary Management of Splenic Artery Aneurysms." Journal of Vascular Surgery 53.4 (2011): 1157.</ref> | |||
==See Also== | ==See Also== | ||
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<references/> | <references/> | ||
[[Category:Vascular]][[Category:GI]][[Category:Surgery]] | [[Category:Vascular]] | ||
[[Category:GI]] | |||
[[Category:Surgery]] | |||
Revision as of 14:03, 3 February 2017
Background
- The most common visceral arterial aneurysm, and the third most common abdominal aneurysm (after aorta and iliac vessels)
- Incidence on CT = 0.8%[1]
- Female:Male 4:1
- 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-ruputre
Clinical Features
- Typically asymptomatic (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 hemoparitoneum if ruptured
- Ruptured ectopic pregnancy
Evaluation
- CTA Abdomen/Plevis 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
- ↑ 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.
- ↑ Parrish J, Maxwell C, Beecroft J. Splenic Artery Aneurysm in Pregnancy. JOGC. 2015; 37(9):816–818.
- ↑ 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
- ↑ Lakin, Ryan O., MD. "The Contemporary Management of Splenic Artery Aneurysms." Journal of Vascular Surgery 53.4 (2011): 1157.