Splenic artery aneurysm: Difference between revisions
Neil.m.young (talk | contribs) No edit summary |
Neil.m.young (talk | contribs) No edit summary |
||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
*The most common visceral arterial aneurysm, and the third most common abdominal aneurysm after the aorta and iliac vessels | *The most common visceral arterial aneurysm, and the third most common abdominal aneurysm after the aorta and iliac vessels | ||
*The incidence of splenic artery aneurysms on CT is 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> | *The incidence of splenic artery aneurysms on CT is 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> | ||
==Clinical Features== | ==Clinical Features== | ||
| Line 7: | Line 7: | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
* Calcified left adrenal haematoma | *Calcified left adrenal haematoma | ||
*Other causes of hemoparitoneum if ruptured | |||
==Diagnosis== | ==Diagnosis== | ||
*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 | ||
*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/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> | ||
==Management== | ==Management== | ||
* Emergent laparotomy for ruptured aneurysm | *Emergent laparotomy or endovascular ablation for ruptured aneurysm | ||
==Disposition== | ==Disposition== | ||
*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 | *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 | ||
*Greater than 2cm: Requires consult with a vascular surgeon for ligation or embolization | *Greater than 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> | ||
*Less than 2cm: Discharge with follow up with PCP or vascular surgeon for surveillance scans at six months and then every 1-2 years<ref>Abbas, Maher A. "Splenic Artery Aneurysms: Two Decades Experience at Mayo Clinic." Annals of Vascular Surgery 16.4 (2002): 442-49. </ref><ref name="khosa" /> | *Less than 2cm: Discharge with follow up with PCP or vascular surgeon for surveillance scans at six months and then every 1-2 years<ref>Abbas, Maher A. "Splenic Artery Aneurysms: Two Decades Experience at Mayo Clinic." Annals of Vascular Surgery 16.4 (2002): 442-49. </ref><ref name="khosa" /> | ||
==See Also== | ==See Also== | ||
*[[Abdominal aortic aneurysm]] | |||
==External Links== | ==External Links== | ||
Revision as of 01:19, 30 December 2015
Background
- The most common visceral arterial aneurysm, and the third most common abdominal aneurysm after the aorta and iliac vessels
- The incidence of splenic artery aneurysms on CT is 0.8%[1]
Clinical Features
- Typically asymptomatic as most are incidental findings on CT
- Can cause epigastric/abdominal pain and hemodynamic instability if ruptured
Differential Diagnosis
- Calcified left adrenal haematoma
- Other causes of hemoparitoneum if ruptured
Diagnosis
- Initial FAST exam may show fluid in left upper quadrant if ruptured aneurysm
- CTA Abdomen/Plevis is the gold standard[2]
Management
- Emergent laparotomy or endovascular ablation for ruptured aneurysm
Disposition
- 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
- Greater than 2cm: Requires consult with a vascular surgeon for ligation or embolization[3]
- Less than 2cm: Discharge with follow up with PCP or vascular surgeon for surveillance scans at six months and then every 1-2 years[4][1]
See Also
External Links
References
- ↑ 1.0 1.1 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.
- ↑ 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.
- ↑ Abbas, Maher A. "Splenic Artery Aneurysms: Two Decades Experience at Mayo Clinic." Annals of Vascular Surgery 16.4 (2002): 442-49.