Imaging Pearls ❯ Vascular ❯ Splenic artery
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- Visceral artery aneurysms (VAAs) consist of aneurysms of the splanchnic circulation, namely, the splenic, hepatic, celiac, superior, and inferior mesenteric and gastroduodenal arteries and the pancreaticoduodenal arcade. VAAs are relatively rare and typically asymptomatic until rupture, which carries an estimated mortality of 25%.
- ”Of VAAs, splenic artery aneurysms (SAAs) are the most common type and comprise approximately 60% . They are four times more likely to occur in women. SAAs in men, however, are three times more likely to rupture. SAAs are more common in multiparous women and present in 9–50% of patients with cirrhosis. Pseudoaneurysms of the splenic artery are also rare, with only a few reported cases in the literature. ”
Visceral Artery Aneurysms
Jonathan Parks and George C. Velmahos F. Coccolini, F. Catena (eds.),
Textbook of Emergency General Surgery https://doi.org/10.1007/978-3-031-22599-4_104
- “Angiosarcoma is an extremely rare tumor but is the most common primary non-hematolymphoid malignancy. It is an extremely aggressive neoplasm with widespread metastasis and splenic rupture common presenting manifestations. The most common CT finding is a patient with splenomegaly (60%) containing a large heterogenous solid mass or masses that nearly replace the spleen.”
MDCT Findings of Splenic Pathology
Sangster GP et al.
Current Problems in Diagnostic Radiology 2021 (in press) - “Splenic artery aneurysms are the most frequent of visceral artery aneurysms. Splenic artery aneurysms may be intra or extra-splenic and most of the cases are calcified. If it measures more than 2.0 cm, there is high risk of rupture (76% fatal), and are often treated.Women with more than two pregnancies have high predisposition to aneurysm rupture and are often treated more aggressively.”
MDCT Findings of Splenic Pathology
Sangster GP et al.
Current Problems in Diagnostic Radiology 2021 (in press)
- Splenic Artery Aneurysm
Splenic artery aneurysms, defined as a dilation of greater than 1 cm in diameter, are the most common type of VAAs. Over 80% of patients with splenic aneurysms are asymptomatic. The small subset of symptomatic individuals typically present with epigastric pain, nausea, vomiting, or anorexia. Spontaneous rupture is the presenting complication in up to 10% of all SAAs, but the prevalence increases to 28% in giant SAA (more than 10 cm in size). - Splenic Artery Pseudoaneurysms: Causes
- pancreatitis,
- blunt abdominal trauma
- gastric ulcers
- iatrogenic injury to the splenic artery - Splenic Artery Aneurysms: Causes
- atherosclerosis,
- fibromuscular dysplasia
- vasculitis
- cirrhosis, and portal hypertension
- systemic hypertension
- atherosclerosis
- “Spontaneous rupture of a splenic artery aneurysm is rare, especially for smaller (<2 cm) aneurysms, but may occur, usually with larger aneurysms. Additional risk factors associated with rupture include rapidly increasing size, occurrence in women of childbearing years, cirrhosis (especially associated with α1 antitrypsin deficiency), and symptoms that can be attributable to the aneurysm.”
Managing Incidental Findings on Abdominal and Pelvic CT and MRI, Part 2: White Paper of the ACR Incidental Findings Committee II on Vascular Findings
Khosa F et al
J Am Coll Radiol. 2013 Oct;10(10):789-94 - “The surgical literature suggests a consensus that such an aneurysm should be considered for endovascular therapy when ≥2 cm. Smaller aneurysms probably can be safely followed, although the clinical risk factors for rupture should be carefully assessed. In one review of patients who were followed with small splenic artery aneurysms, the mean aneurysm growth rate was 0.06 cm/y, with the most rapid growth rate noted to be 1 cm over 63 months. In this group of patients, none of the aneurysms ruptured. Given these data, yearly surveillance for small splenic artery aneurysms is recommended, although for the smaller aneurysms among those ≥2 cm, surveillance intervals of >1 year may be reasonable, depending on comorbidities and life expectancy.”
Managing Incidental Findings on Abdominal and Pelvic CT and MRI, Part 2: White Paper of the ACR Incidental Findings Committee II on Vascular Findings
Khosa F et al
J Am Coll Radiol. 2013 Oct;10(10):789-94
“Spontaneous rupture of a splenic artery aneurysm is rare, especially for smaller (<2 cm) aneurysms, but may occur, usually with larger aneurysms. Additional risk factors associated with rupture include rapidly increasing size, occurrence in women of childbearing years, cirrhosis (especially associated with α1 antitrypsin deficiency), and symptoms that can be attributable to the aneurysm.”
Managing Incidental Findings on Abdominal and Pelvic CT and MRI, Part 2: White Paper of the ACR Incidental Findings Committee II on Vascular Findings
Khosa F et al
J Am Coll Radiol. 2013 Oct;10(10):789-94“The surgical literature suggests a consensus that such an aneurysm should be considered for endovascular therapy when ≥2 cm. Smaller aneurysms probably can be safely followed, although the clinical risk factors for rupture should be carefully assessed. In one review of patients who were followed with small splenic artery aneurysms, the mean aneurysm growth rate was 0.06 cm/y, with the most rapid growth rate noted to be 1 cm over 63 months. In this group of patients, none of the aneurysms ruptured. Given these data, yearly surveillance for small splenic artery aneurysms is recommended, although for the smaller aneurysms among those ≥2 cm, surveillance intervals of >1 year may be reasonable, depending on comorbidities and life expectancy.”
Managing Incidental Findings on Abdominal and Pelvic CT and MRI, Part 2: White Paper of the ACR Incidental Findings Committee II on Vascular Findings
Khosa F et al
J Am Coll Radiol. 2013 Oct;10(10):789-94
- Splenic Artery Aneurysm: Facts
- 3rd most common intra-abdominal aneurysm
- Frequency of 0.2% to 10.4%
- 4x more common in woman
- 3x more likely to rupture in men - Splenic Artery Aneurysm: Associated Conditions
- Atherosclerosis
- Hypertension
- Portal hypertension
- Cirrhosis
- Pregnancy
- Liver transplantation - Splenic Artery Pseudoaneurysms: Associated With
- Pancreatitis
- Trauma
- Post operative complication
- Peptic ulcer disease - Splenic Artery Pseudoaneurysms: Presentation
- abdominal pain
- melana or hematochezia
- hematemasis
- fact: pseudoaneurysms rupture in up to 37% of cases with mortality then approaching 90% - “The Amplatzer septal occluder is very efficient and offered interventional ASD closure in 84.7% of our group of consecutive patients, with excellent intermediate results.”
Experience with transcatheter closure of secundum atrial septal defects using the Amplatzer septal occluder: a single centre study in 236 consecutive patients
G Fischer et al.
Heart Feb 2003; 89(2):199-204 - “The ease of implantation and the superior success rate of ASD closure with the Amplatzer septal occluder has led to the widespread employment of transcatheter occlusion of ASD and has replaced routine surgical closure in many centres. There is no doubt that this success rate is a result of the design of the Amplatzer occluder, which is completely different from the patch type systems. The most important aspect is that the device’s waist between the left and right retention discs is a stent, resulting in self centring within the defect.”
Experience with transcatheter closure of secundum atrial septal defects using the Amplatzer septal occluder: a single centre study in 236 consecutive patients
G Fischer et al.
Heart Feb 2003; 89(2):199-204 - “The AMPLATZER Septal Occluder is a device specifically designed to close an ASD. The device is implanted during a catheter-based procedure and remains permanently implanted. The device is made from a braided metal (Nitinol) that has shape memory characteristics; this means the device will go back to its original shape even after it is stretched to pass through a catheter.”
- St. Jude Medical
- Splenic Artery Aneurysms: Etiologies
-Atherosclerosis
-Portal hypertension
-Hepatic transplant
-Pregnancy
-Collagen vascular disease
-Cirrhosis