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CLINICAL IMAGES
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Splenic artery aneurysm: Interesting images Â
Sayf Altabaqchali, Mohanad Hasan, Ahmed Altabaqchali ABSTRACT Abstract is not required for Clinical Images
International Journal of Case Reports and Images (IJCRI) International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties. Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. IJCRI publishes Review Articles, Case Series, Case Reports, Case in Images, Clinical Images and Letters to Editor. Website: www.ijcasereportsandimages.com
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Int J Case Rep Images 2017;8(6):420–422. www.ijcasereportsandimages.com
CASE CLINICAL REPORT IMAGES
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Splenic artery aneurysm: Interesting images Sayf Altabaqchali, Mohanad Hasan, Ahmed Altabaqchali
CASE REPORT An 80-year-old female with past medical history of hypertension, hyperlipidemia, diabetes mellitus type 2, and history of remote smoking presented to her primary care doctor for evaluation of ten days history of cough. She did not report any chest pain, shortness of breath, or fever. Her physical examination was unremarkable. two view chest X-ray revealed a clear lung parenchyma with normal heart size, calcific thoracic aorta, and an interesting incidental finding of possible splenic artery aneurysm (Figures 1 and 2). The patient was asymptomatic; she denied left upper quadrant pain, nausea, or vomiting. Computed tomography (CT) scan of the abdomen demonstrated significant atherosclerotic changes of the aorta without aneurysmal dilation, normal renal and mesenteric arteries, a partially calcified splenic artery aneurysm measuring maximum diameter of 2.0 cm, and there is also an area of the splenic artery ectasia where the vessel diameter reaches 0.8 cm (Figures 3 and 4). After a detailed discussion with vascular surgery and interventional cardiology; the multidisciplinary team decided to monitor the patient every six months. In event of aneurysmal enlargement more than 2.5 cm, the patient will be a candidate for elective splenic artery aneurysm procedure.
Sayf Altabaqchali1, Mohanad Hasan1, Ahmed Altabaqchali1 Affiliations: 1Ochsner Heart and Vascular Institute, 1514 Jefferson Highway, New Orleans, LA, USA.. Corresponding Author: Sayf Altabaqchali, MD, RPVI, Ochsner Heart and Vascular Institute, 1514 Jefferson Highway, New Orleans, LA 70121, USA; Email: saltabaqchali@gmail.com Received: 01 March 2017 Accepted: 28 March 2017 Published: 01 June 2017
Figure 1: Posteroanterior view chest X-ray. The arrow indicates the calcific splenic artery.
DISCUSSION Splenic artery aneurysm is common visceral aneurysm; it is the third most common aneurysm after abdominal aortic and iliac aneurysms. Most of the time patients are asymptomatic, found incidentally during routine investigations. It can cause left upper quadrant abdominal pain, nausea, and vomiting. In rare cases, it could rupture and leads to shock [1]. Risk factors include hypertension, atherosclerosis, and iatrogenic during abdominal surgeries. There is no consensus when to operate, but it has been suggested that pregnant women, symptomatic patients should undergo repair procedure [2]. It is often difficult to correctly diagnose splenic artery aneurysm in asymptomatic patients who present with only chest X-ray or abdominal ultrasound; differential diagnosis included pancreatic
International Journal of Case Reports and Images, Vol. 8 No. 6, June 2017. ISSN – [0976-3198]
Int J Case Rep Images 2017;8(6):420–422. www.ijcasereportsandimages.com
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Figure 4: Computed tomography angiography, axial plane. The arrow indicates the calcific splenic artery.
Figure 2: Lateral view chest X-ray showing clear lung parenchyma.
factor to decide which procedural approach the doctors should take [4, 5]. Timing for repair in asymptomatic patients is not standardized, but asymptomatic aneurysm of size 1–2 cm can be monitored safely every six months with an imaging method [6].
CONCLUSION Splenic artery aneurysm is the third common abdominal aneurysm yet it is still rare, we present this nice chest X-ray. Splenic artery aneurysm is not just a radiographic diagnosis alone; it requires confirmation with other either computed tomography angiography and/or Doppler ultrasound. In this case, we will do a follow-up computed tomography scan in six months. Figure 3: Computed tomography angiography scan coronal plane. The arrow indicates the calcific splenic artery.
cyst, pancreatic tumor, calcified left adrenal hematoma. Computed tomography and or magnetic resonance angiography can easily recognize the splenic artery aneurysm [3]. There is no specific guidelines on how to treat asymptomatic splenic artery aneurysm, though it is widely accepted to evaluate any aneurysm size more than 2.0 cm. for possible intervention. Treatment modality can be either endovascular or surgical; percutaneous intervention with either coil embolization or covered stent have been associated with a better short-term results compared to open repair, while open repair has less long-term complications including less re-exploratory procedures. The main indications for either types of the intervention are symptomatic patients, pregnancy, and pseudoaneurysm. Splenic artery anatomy is the main
Keywords: Aneurysm, Asymptomatic, Imaging, Spleen, Splenic artery How to cite this article Altabaqchali S, Hasan M, Altabaqchali A. Splenic artery aneurysm: Interesting images. Int J Case Rep Images 2017;8(6):420–422.
Article ID: Z01201706CL10125SA ********* doi:10.5348/ijcri-201715-CL-10125
International Journal of Case Reports and Images, Vol. 8 No. 6, June 2017. ISSN – [0976-3198]
Int J Case Rep Images 2017;8(6):420–422. www.ijcasereportsandimages.com
********* Author Contributions
Sayf Altabaqchali – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Mohanad Hasan – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published Ahmed Altabaqchali – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor
The corresponding author is the guarantor of submission.
Conflict of Interest
Authors declare no conflict of interest.
Copyright
© 2017 Sayf Altabaqchali et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited.
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REFERENCES 1.
Yamamoto S, Hirota S, Maeda H, et al. Transcatheter coil embolization of splenic artery aneurysm. Cardiovasc Intervent Radiol 2008 May– Jun;31(3):527–34. 2. Góes Junior AM, Góes AS, de Albuquerque PC, Palácios RM, Abib Sde C. Endovascular treatment of giant splenic artery aneurysm. Case Rep Surg 2012;2012:964093. 3. Tcbc-Rj RA, Ferreira MC, Ferreira DA, Ferreira AG, Ramos FO. Splenic artery aneurysm. Rev Col Bras Cir 2016 Sep–Oct;43(5):398–400. 4. Hogendoorn W, Lavida A, Hunink MG, et al. Open repair, endovascular repair, and conservative management of true splenic artery aneurysms. J Vasc Surg 2014 Dec;60(6):1667–76.e1. 5. Tulsyan N, Kashyap VS, Greenberg RK, et al. The endovascular management of visceral artery aneurysms and pseudoaneurysms. J Vasc Surg 2007 Feb;45(2):276–83; discussion 283. 6. Pasha SF, Gloviczki P, Stanson AW, Kamath PS. Splanchnic artery aneurysms. Mayo Clin Proc 2007 Apr;82(4):472–9.
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International Journal of Case Reports and Images, Vol. 8 No. 6, June 2017. ISSN – [0976-3198]
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