Year : 2003 | Volume
: 13 | Issue : 4 | Page : 399--400
Splenic artery pseudoaneurysm associated with blunt abdominal trauma
R Malik, VK Pandya, D Naik
Department of Radiodiagnosis, Gandhi Medical College, Bhopal, India
Department of Radiodiagnosis, Gandhi Medical College, Bhopal
|How to cite this article:|
Malik R, Pandya V K, Naik D. Splenic artery pseudoaneurysm associated with blunt abdominal trauma.Indian J Radiol Imaging 2003;13:399-400
|How to cite this URL:|
Malik R, Pandya V K, Naik D. Splenic artery pseudoaneurysm associated with blunt abdominal trauma. Indian J Radiol Imaging [serial online] 2003 [cited 2020 Sep 23 ];13:399-400
Available from: http://www.ijri.org/text.asp?2003/13/4/399/28717
Pseudoaneurysm of splenic artery is an uncommon complication associated with traumatic pancreatitis. Pseudoaneurysm can occur in any vessel around pancreas but it is most common in the splenic artery which is involved in about 60% cases due to its contiguity with pancreas. The reported incidence of splenic artery pseudoaneurysm in autopsy series ranges from 0.098% to 10.4%. It is important to recognize this uncommon arterial complication as it can rupture & cause G.I. bleeding.
A 40 year old male patient presented with epigastric pain. He had a history of blunt abdominal trauma 12years back. CBP revealed low Hb - 6gm%. USG was performed at our institution by 3.5MHz & 6.5MHz convex probes on WIPRO G.E. machine. USG revealed a well defined heterogenous lesion with a cystic component, adjacent to body & tail of pancreas anteriorly. COLOUR DOPPLER revealed colour flow in the cystic component of the lesion with neck of the lesion arising from splenic artery. DYNAMIC CT SCAN performed by spiral CT scanner - WIPRO GE, after injecting 60cc omnipaque IN, revealed a well defined heterogenous lesion with hypodense to isodense area (HU +54) and cystic component (HU +16) within it adjacent to body & tail of pancreas with small flecks of calcification in wall of the lesion, which showed uniform homogenous enhancement of cystic component with nonenhancing hypodense rim surrounding it. CT ANGIOGRAPHY was then performed after injecting 100cc omnipaque i.v. which revealed significant enhancement of the cystic component of the lesion equal to that of aorta with surrounding nonenhancing hypodense rim. Maximum intensity projection (axial) and shaded surface display of CT angiographic images was performed which distinctly revealed that the neck of the lesion was arising from splenic artery thus confirming the diagnosis of splenic artery pseudoaneurysm with partial thrombosis.
Splenic artery aneurysms are the most frequent visceral artery aneurysm accounting for as many as 60% of all the splanchnic artery aneurysms. The common etiologies include pancreatitis, trauma, congenital, mycotic, fibromuscular dysplasia, medial degeneration with superimposed atherosclerosis and after resection of biliopancreatic cancer Splenic artery is involved most frequently (30-50%) followed by gastroduodenal artery (1015%) & pancreaticoduodenal arteries (10%). The pathogenesis of these aneurysms are:
(a) enzyme rich peripancreatiuc fluid often within a pseudocyst, leads to auto-digestion & weakening of the walls of adjacent arteries.
(b) rupture of aneurysm into pseudocyst converts it into a pseudoaneurysm.
(c) these peripancreatic arteries undergo aneurysmal dilatation with the aneurysmal bulge most often contained in pseudocyst.
The clinical picture may vary widely as follows: (a) anemia of unexplained cause as in this patient. (b) bleeding from pseudoaneurysm through pancreatic duct and subsequently ampulla of Vater causing recurrent or intermittent haematemesis or melena. (c) if the pseudoaneurysm does not communicate with pancreatic duct, then blood accumulates within it leading to its enlargement & abdominal pain and a drop in haematocrit value as in this case.
Management is either by transarterial catheter angioembolization with or without stent placement or by surgical resection of the pseudoaneurysm.
|1||Cahow CE, Gusberg RJ, Gottlieb LJ:Gastrointestinal haemorrhage from pseudoaneurysms in pancreatic pseudocyst.1983Apr;145(4):534-41.|
|2||Vanlangenhove P, Defreyne L, Kunnen' M:Spontaneous thrombosis of a pseudoaneurysm complicating pancreatitis. 1 999Sep-oct;24(5):491-3.|
|3||White AF, Baum S, Buranasiri S:Aneurysms secondary topancreatitis.AJR1976;127:393-6 .|
|4||Pantograg-Brown L, Suwanwela N, Arjhansiri K, et al: Demonstration on CT of two pseudoaneurysms complicating chronic pancreatitis.Br J Radiol 1991;64:754-757.|
|5||BurkeWJ, Ericson JS, Kellum DC et al:Pseudoaneurysm complicating pancreatitis: Detection by ct. radiology 1986;161:447-50|
|6||McDermottVG,Schlansky-GoldbergR,Cope C.Endovascular management of splenic artery aneurysms and pseudoaneuyrysms.Cardiovasc-IntRadilogy 1994;17:179-184.|