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 aorta and iliac vessels) | *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 | *Etiologies include arterial fibrodysplasia, portal hypertension, and increased splenic AV shunting in pregnancy | ||
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**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-rupture | **High maternal and fetal mortality post-rupture | ||
==Clinical Features== | ==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) | |||
*Typically asymptomatic or vague with [[Special:MyLanguage/left upper quadrant pain|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 hemoperitoneum if ruptured | *Other causes of hemoperitoneum if ruptured | ||
**Ruptured [[ectopic pregnancy]] | **Ruptured [[Special:MyLanguage/ectopic pregnancy|ectopic pregnancy]] | ||
==Evaluation== | ==Evaluation== | ||
*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> | *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 [[Special:MyLanguage/FAST exam|FAST exam]] may show fluid in left upper quadrant if ruptured aneurysm | ||
==Management== | ==Management== | ||
*Surgery and/or IR consult | *Surgery and/or IR consult | ||
*Ruptured aneurysm requires emergent laparotomy or endovascular intervention | *Ruptured aneurysm requires emergent laparotomy or endovascular intervention | ||
==Disposition== | ==Disposition== | ||
*Discharge: | *Discharge: | ||
**Aneurysm size <2cm, asymptomatic, and hemodynamically stable | **Aneurysm size <2cm, asymptomatic, and hemodynamically stable | ||
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*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 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> | *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== | ||
*[[Abdominal aortic aneurysm]] | |||
*[[Special:MyLanguage/Abdominal aortic aneurysm|Abdominal aortic aneurysm]] | |||
==External Links== | ==External Links== | ||
==References== | ==References== | ||
<references/> | <references/> | ||
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[[Category:GI]] | [[Category:GI]] | ||
[[Category:Surgery]] | [[Category:Surgery]] | ||
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Latest revision as of 23:58, 4 January 2026
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
- Ruptured ectopic pregnancy
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
- ↑ 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.