Splenic artery aneurysm

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]
  • Female:Male 4:1

Clinical Features

  • Typically asymptomatic as most are incidental findings on CT
  • Can cause epigastric/abdominal pain and hemodynamic instability if ruptured
  • 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

Differential Diagnosis

  • Calcified left adrenal haematoma
  • Other causes of hemoparitoneum if ruptured
    • Ruptured ectopic pregnancy

Evaluation

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

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[4]
  • Less than 2cm: Discharge with follow up with primary care provider or vascular surgeon for surveillance scans at six months and then every 1-2 years[5][1]

See Also

External Links

References

  1. ↑ 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.
  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.
  5. ↑ Abbas, Maher A. "Splenic Artery Aneurysms: Two Decades Experience at Mayo Clinic." Annals of Vascular Surgery 16.4 (2002): 442-49.
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