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Year : 2006  |  Volume : 16  |  Issue : 4  |  Page : 543-544
Ruptured splenic artery aneurysm


Department of Radiology and Imaging, L.G. General Hospital. K.M. School Of Post Graduate And Research Institute. Smt. N.H.L. Mumicipal Medical College, Ahmedabad, India

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Date of Submission06-Mar-2006
Date of Acceptance10-Aug-2006
 

Keywords: Splenic artery aneurysm, Color Doppler, Contrast enhanced CT

How to cite this article:
Raval H B, Agarwal G R, Sagar R P, Dave A N, Patel V B. Ruptured splenic artery aneurysm. Indian J Radiol Imaging 2006;16:543-4

How to cite this URL:
Raval H B, Agarwal G R, Sagar R P, Dave A N, Patel V B. Ruptured splenic artery aneurysm. Indian J Radiol Imaging [serial online] 2006 [cited 2019 Dec 13];16:543-4. Available from: http://www.ijri.org/text.asp?2006/16/4/543/32264

   Introduction Top


Splenic artery aneurysms are rare but important vascular lesion that occur in upto 10 % of patient with cirrhosis and portal hypertension. [1]


   Case report Top


A 50 years old female patient came to hospital with complaints of abdominal pain on left side. Patient was known case of hypertension since last 15 years and taking regular antihypertensive drugs.

Radiograph of abdomen and KUB was normal.

Ultrasonography of abdomen was performed which showed large mass of hetrogenous echogenicity on left side of abdomen in the region of tail of pancreas and at splenic hilum. Mass showed cystic area surrounded by echogenic material with whorl like appearance typical of hematoma. Mass displacing the spleen more superiorly.[Figure - 1]

On colour doppler study hypoechoic lesion showed presence of blood flow suggest vascular nature of lesion and there was possibility of splenic artery aneurysm was considered.[Figure - 2]

CT scan of abdomen was performed subsequently showed 4 x 3 cm sized hypodense lesion in relation to distal portion of splenic artery at splenic hilum, which showed intense enhancement in arterial phase of contrast study suggest splenic artery aneurysm. Large hematoma was noted posterior 2 to it and multiple splenic infarcts were noted which suggest ruptured of splenic artery aneurysm. [Figure - 3],[Figure - 4]

The patient was operated and per operation findings showed large hematoma surrounding the ruptured splenic artery aneurysm. [Figure - 5]


   Discussion Top


Eight to ten percentage of patient with cirrhosis and portal hypertension have splenic artery anerysms, a ten fold increase compared with the general population. Although the pathogenesis of splenic artery aneurysm in patient with cirrhosis is not fully understood, portal hypertension and the hyperdynamic flow associated with cirrhosis appears to be predisposing factors.[1]

Hormonal changes similar to those seen during pregnancy have been implicated in contributing to increased weakening of vessel walls and aneurysmal rupture. These hormonal changes are the result of decreased catabolism due to chronic liver disease. [2]

Acute left upper quadarant pain and shock usually indicate rupture of the aneurysm, which occurs in five to ten percentage of the cases. [3]

Spenic artery aneurysms are diagnosed when a curvilinear calcification is seen in relation to the splenic artery on conventional radiographs or incidentally during ultrasound or CT examination of the abdomen.[4]

On ultrasound examination splenic artery aneurysm appears as hypoechoic masses in left upper part of the abdomen. Duplex ultrasound examination may show a holosystolic waveform. On CT scans splenic artery aneurysm appears as well defined low density masses with or without calcifications. Intense enhancement within the residual patent lumen following the administration of intravenous contrast medium confirms the diagnosis of the aneurysm. MRI is helpful in such cases. [4]

Surgical treatment includes ligation of the splenic artery or resection of the splenic artery. Once rupture has occurred, artery is resected along with the spleen, sometimes together with partial distal pancreatectomy as well. Super selective embolisation of the splenic artery is an important alternative method of treatment in high risk patient. [5]

 
   References Top

1.AJR 2002; 179 : 1327-1329  Back to cited text no. 1    
2.Medline, splenic artery aneyrysm in liver transplantation patient, J. Hepatol 1997; 27 : 890-893. Kobon L, Vander Kolk MJ, de Jong KP, etal.  Back to cited text no. 2    
3.Management of the true aneurysm of splenic artery; Am J surg. 1998; 175 : 466-468. Perrot MD, Buhler L, Deleval J.  Back to cited text no. 3    
4.BJR 1998; 71 : 46-6. Kehagias DT, Tzalnikos MJ, Moulopolos LA etal. MRI of a giant splenic artery aneurysm.  Back to cited text no. 4    
5.Cardiovascular Interventional Radiol, 1994; 17 : 179-184 Endovascular management of splenic artery aneurysm and psudoaneurysms. M.C. Dermott V, Shlansky Goldberg R, Copec C.  Back to cited text no. 5    

Top
Correspondence Address:
H B Raval
Department of Radiology and Imaging, L.G. General Hospital. K.M. School of Post Graduate And Research Institute. Smt. N.H.L. Mumicipal Medical College, Ahmedabad
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-3026.32264

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    Figures

  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5]

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