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splenica_aneurysm

splenic artery aneurysm

Introduction

  • rare cause of abdominal pain and may be the result of arterial or venous occlusion
  • often is the presenting complaint of an underlying condition
  • usually in a person with an underlying hematologic disorder (eg. sickle cell disease (SCD)), hypercoagulable state, blood-borne malignancy causing splenomegaly, blunt abdominal trauma, pancreatitis, compressive pancreatic masses, or embolic illness.
  • 1/3rd have splenomegaly; 1/3rd have a fever; over half have a raised WCC; over 2/3rds have raised LDH;
  • splenic artery aneurysm with distended thin wall and impending rupture
  • rare, but a condition to consider in 2nd or 3rd TM of pregnancy, portal hypertension, liver transplant, pancreatitis, hypertension, atherosclerosis, Marfans, trauma, large vessel vasculitis, etc
  • prevalence of splenic artery aneurysm is 0.04% to 0.10% at arteriography and autopsy
  • 78% are in women 1)
    • 50% of those that occur in pregnant women will rupture during pregnancy! Two-thirds of SAA rupture in the third trimester and typically in the last two weeks of pregnancy. 2)
  • accounts for about 60% of visceral arterial aneurysms (remainder are mainly renal artery aneurysms)

Clinical presentation

  • may present with episodic LUQ pains often lasting 24hrs +/- radiation to L shoulder
  • may be detected as a cystic mass near the pancreas on US if not obese, or CTKUB
  • may present after rupture with hypovolaemic shock, abdo/chest pain and positive FAST USS

Management of unruptured aneurym

  • early diagnosis with contrast CT is critical to manage prior to rupture
  • risk of rupture is 2% to 10% (much higher in pregnant patients)
  • intervention prior to rupture is usually recommended if either:
    • aneurysm size larger than 2 or 2.5 cm
    • growth of the aneurysm by 3 to 5 mm or more during surveillance regardless of initial size
    • symptomatic
    • women of childbearing age
    • portal hypertension
    • planned liver transplant
  • mortality of intervention options is said to be ~1% 3)
    • complications of intervention include postembolization syndrome, splenic infarction or abscess, and pancreatitis

Mx of ruptured splenic artery

  • ruptured splenic artery aneurysm - this may be rapidly fatal mortality is over 25% (maternal mortality due to SAA rupture increases up to 75%, and fetal mortality increases as high as 95%)
    • usually present in hypovolaemic shock with abdominal or chest pain and positive FAST US (DDx ruptured ectopic or spleen), but may also have haematuria
    • patients in shock needing massive blood transfusion to keep alive should probably go straight to theatre for surgical intervention rather than radiologic intervention
splenica_aneurysm.txt · Last modified: 2022/08/06 02:51 by wh

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