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Herrera-Ortiz AF, Del Castillo V, Aguirre D, Duarte JN, Gutierrez MJ, Olarte LM, Noguera V, Quiroz-Alfaro AJ. Spleen anomalies and lesions in CT and MRI: essentials for radiologists and clinicians-a pictorial review. Abdom Radiol (NY) 2024:10.1007/s00261-024-04405-6. [PMID: 39192089 DOI: 10.1007/s00261-024-04405-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 08/29/2024]
Abstract
The precise evaluation of splenic lesions using cross-sectional imaging presents a complex challenge due to the overlapping imaging characteristics of most splenic diseases and the absence of specific symptoms, complicating the diagnosis process. This pictorial review highlights the essential elements that should be included in a radiology report to interpret cross-sectional imaging studies of splenic lesions. To augment the diagnostic accuracy, we propose the implementation of a stepwise algorithmic approach. This approach offers a comprehensive analysis of splenic anomalies and lesions, providing an invaluable tool for radiologists and clinicians.
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Affiliation(s)
- Andrés Felipe Herrera-Ortiz
- Radiology, Fundación Santa Fe de Bogotá, 116 Street # 9-02, 110111, Bogotá, Colombia
- Medicine, Universidad El Bosque, Bogotá, Colombia
| | - Valeria Del Castillo
- Radiology, Fundación Santa Fe de Bogotá, 116 Street # 9-02, 110111, Bogotá, Colombia.
- Medicine, Universidad El Bosque, Bogotá, Colombia.
| | - Diego Aguirre
- Radiology, Fundación Santa Fe de Bogotá, 116 Street # 9-02, 110111, Bogotá, Colombia
- Medicine, Universidad El Bosque, Bogotá, Colombia
| | - José Nicolás Duarte
- Radiology, Fundación Santa Fe de Bogotá, 116 Street # 9-02, 110111, Bogotá, Colombia
- Medicine, Universidad El Bosque, Bogotá, Colombia
| | | | | | - Valeria Noguera
- Radiology, Fundación Santa Fe de Bogotá, 116 Street # 9-02, 110111, Bogotá, Colombia
- Medicine, Universidad El Bosque, Bogotá, Colombia
| | - Alejandro José Quiroz-Alfaro
- Medicine, Universidad del Rosario, Bogotá, Colombia
- Internal Medicine, North Mississippi Medical Center, Tupelo, USA
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2
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Troisi N, Bertagna G, Tomei F, Adami D, Cioni R, Perrone O, Juszczak M, Berchiolli R. Long-term Outcome Comparison of 2 Techniques for Embolization of Splenic Artery Aneurysms. J Endovasc Ther 2024:15266028241255531. [PMID: 38813950 DOI: 10.1177/15266028241255531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
PURPOSE The aim of the study is to analyze our single-center experience in endovascular treatment of splenic artery aneurysms (SAAs) with transcatheter coil embolization, comparing long-term outcomes of packing and sandwich techniques. MATERIALS AND METHODS Between January 2010 and December 2021, 28 patients with certain diagnosis of non-ruptured asymptomatic SAA were treated with 2 different embolization techniques (packing, n=10, and sandwich, n=18). Early outcomes assessed were technical success, overall mortality, mean hospital stay, post-embolization syndrome rate, and freedom from splenectomy rate. Estimated 5-year outcomes in terms of freedom from sac reperfusion, and freedom from reintervention were evaluated and compared between the 2 different embolization techniques. RESULTS The mean SAA diameter was 2.8±0.8 cm. Overall technical success rate was 100%. Intraoperative and 30-day mortality rates were 0 in both groups. One patient in the sandwich group required a postoperative splenectomy. The mean follow-up period was 58.3±44.5 months. Estimated overall 5-year survival was 86.7%. Five-year freedom from sac reperfusion was 100% in the sandwich group, and 85.7% in the packing group, with no difference between the 2 groups (p=0.131), whereas freedom from reintervention was 100% in the sandwich group, and 75% in the packing group with a statistically significant difference (p=0.049; log-rank=3.750). CONCLUSIONS Embolization of SAAs seemed to be safe and effective with 100% of technical success rate and good perioperative results. Both sandwich and packing techniques yielded promising results also in the long-term period. CLINICAL IMPACT Transcatheter coil embolization of splenic artery aneurysms seems to be a safe and effective procedure with a 100% technical success and satisfactory perioperative outcomes. Sandwich and packing techniques offer good results in the long-term period. Freedom from reintervention seems to be optimal and comparable between the 2 techniques.
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Affiliation(s)
- Nicola Troisi
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Giulia Bertagna
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Francesca Tomei
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Daniele Adami
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Roberto Cioni
- Department of Interventional Radiology, Pisa University Hospital, Pisa, Italy
| | - Orsola Perrone
- Department of Interventional Radiology, Pisa University Hospital, Pisa, Italy
| | - Maciej Juszczak
- Department of Vascular Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Raffaella Berchiolli
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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3
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Mahdi M, Bharwad A, Seecheran R, Zakhour J, Kayali M, Mahdi A. Splenic Artery Pseudoaneurysm in a Septic Patient with Acute Pancreatitis. Kans J Med 2023; 16:17-18. [PMID: 36703949 PMCID: PMC9872497 DOI: 10.17161/kjm.vol16.18696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 12/20/2022] [Indexed: 01/20/2023] Open
Affiliation(s)
- Mahmoud Mahdi
- Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Aastha Bharwad
- Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Rajeev Seecheran
- Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Joud Zakhour
- Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Majd Kayali
- Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Ahmad Mahdi
- Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
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Lee SH, Yang S, Park I, Im YC, Kim GY. Ruptured splenic artery aneurysms in pregnancy and usefulness of endovascular treatment in selective patients: A case report and review of literature. World J Clin Cases 2022; 10:9057-9063. [PMID: 36157677 PMCID: PMC9477030 DOI: 10.12998/wjcc.v10.i25.9057] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/25/2022] [Accepted: 07/18/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The rupture of a splenic artery aneurysm (SAA) in pregnancy is an uncommon condition. However, it is associated with high mortality rates in pregnant women and fetuses even after surgical treatment. Though the endovascular treatment of SAAs is currently preferred as it can improve the outcomes even in emergent cases, the endovascular treatment of a ruptured SAA during pregnancy has not been reported until date.
CASE SUMMARY We report a case of a 33-year-old woman with the sudden onset of epigastric pain due to a ruptured SAA at the mid-portion of the splenic artery at 18 wk of pregnancy. After emergent initial resuscitation, the patient was diagnosed with a ruptured SAA through digital angiography. Immediately upon diagnosis, she underwent emergent endovascular embolization of the splenic artery for the rupture on the spot. Next, surgery was performed to remove the hematoma under stable conditions. Although the fetus was found to be dead during resuscitation, the woman recovered without complications and was discharged 15 d postoperatively.
CONCLUSION Endovascular treatment might be a valuable alternative to surgery/lead to safer surgery for selected pregnant patients with ruptured SAAs.
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Affiliation(s)
- Sang Hun Lee
- Department of Obstetrics and Gynecology, Ulsan University and Ulsan University Hospital, Ulsan 44033, South Korea
| | - Songsoo Yang
- Department of Surgery, Ulsan University and Ulsan University Hospital, Ulsan 44033, South Korea
| | - Inkyu Park
- Department of Surgery, Ulsan University and Ulsan University Hospital, Ulsan 44033, South Korea
| | - Yeong Cheol Im
- Department of Surgery, Ulsan University and Ulsan University Hospital, Ulsan 44033, South Korea
| | - Gyu Yeol Kim
- Department of Surgery, Ulsan University and Ulsan University Hospital, Ulsan 44033, South Korea
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5
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Holt JN, Schwalb HE. A case of splenic artery pseudoaneurysm rupture presenting as rectal bleeding in a regional hospital. J Surg Case Rep 2020; 2020:rjaa504. [PMID: 33365119 PMCID: PMC7745148 DOI: 10.1093/jscr/rjaa504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/18/2020] [Indexed: 12/02/2022] Open
Abstract
Splenic artery pseudoaneurysm is a rare phenomenon most associated with chronic pancreatitis or previous trauma. Complications can include erosion and rupture into local structures, a situation that carries a reported mortality of 10–40%. A 58-year-old male with chronic alcoholic pancreatitis and a known splenic artery pseudoaneurysm presented to the emergency department of a regional hospital with rectal bleeding and sepsis. Computed tomography revealed a peri-splenic mass communicating with the splenic flexure. The patient was taken for an emergency splenectomy and left hemicolectomy and was confirmed to have rupture of the splenic artery aneurysm into the large bowel. This case presented with comparable features reported in the literature and demonstrates that access to emergency specialist surgical services in a regional setting offers the capability to manage rare, life threatening surgical emergencies.
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Affiliation(s)
- Jonathon N Holt
- General Surgery Department, Albury-Wodonga Health, Albury, NSW, Australia
| | - Heinrich E Schwalb
- General Surgery Department, Albury-Wodonga Health, Albury, NSW, Australia
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Selim M, Awad Albayomy A, Almuhaish LA, Alraddadi SA, Alharbi WM. Multiple Incidental Unruptured Splenic Artery Aneurysms Following Severe Trauma. Cureus 2020; 12:e11136. [PMID: 33133794 PMCID: PMC7586417 DOI: 10.7759/cureus.11136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Splenic artery aneurysm is a relatively rare, potentially life-threatening condition due to its high potential for rupture. We report a case of two incidentally found unruptured splenic artery aneurysms in a 39 year-old female victim of severe trauma resulting from a motor vehicle accident (MVA). Management by coiling of the splenic artery aneurysm and embolization to the entire segment distal to it was successfully performed for this patient.
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Affiliation(s)
- Mohamed Selim
- Vascular Surgery, King Fahad University Hospital, Dammam, SAU
| | | | | | | | - Wasan M Alharbi
- Vascular Surgery, King Fahad University Hospital, Dammam, SAU
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Clément M, Lareyre F, Loste A, Sannier A, Burel-Vandenbos F, Massiot N, Carboni J, Jean-Baptiste E, Caligiuri G, Nicoletti A, Raffort J. Vascular Remodeling and Immune Cell Infiltration in Splenic Artery Aneurysms. Angiology 2020; 72:539-549. [PMID: 32851875 DOI: 10.1177/0003319720952290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Rupture of splenic artery aneurysms (SAAs) is associated with a high mortality rate. The aim of this study was to identify the features of SAAs. Tissue sections from SAAs were compared to nonaneurysmal splenic arteries using various stains. The presence of intraluminal thrombus (ILT), vascular smooth muscle cells (VSMCs), cluster of differentiation (CD)-68+ phagocytes, myeloperoxidase+ neutrophils, CD3+, and CD20+ adaptive immune cells were studied using immunofluorescence microscopy. Analysis of SAAs revealed the presence of atherosclerotic lesions, calcifications, and ILT. Splenic artery aneurysms were characterized by a profound vascular remodeling with a dramatic loss of VSMCs, elastin degradation, adventitial fibrosis associated with enhanced apoptosis, and increased matrix metalloproteinase 9 expression. We observed an infiltration of immune cells comprising macrophages, neutrophils, T, and B cells. The T and B cells were found in the adventitial layer of SAAs, but their organization into tertiary lymphoid organs was halted. We failed to detect germinal centers even in the most organized T/B cell follicles and these lymphoid clusters lacked lymphoid stromal cells. This detailed histopathological characterization of the vascular remodeling during SAA showed that lymphoid neogenesis was incomplete, suggesting that critical mediators of their development must be missing.
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Affiliation(s)
- Marc Clément
- Université de Paris, LVTS, 121283INSERM U1148, Paris, France
| | - Fabien Lareyre
- Department of Vascular Surgery, 26992University Hospital of Nice, France.,Department of Vascular Surgery, University Hospital of Antibes-Juan-les-Pins, France.,439710Université Côte d'Azur, CHU, INSERM U1065, C3M, Nice, France
| | - Alexia Loste
- Université de Paris, LVTS, 121283INSERM U1148, Paris, France
| | - Aurélie Sannier
- Université de Paris, LVTS, 121283INSERM U1148, Paris, France
| | | | - Nicolas Massiot
- Department of Vascular Surgery, 26992University Hospital of Nice, France
| | - Joseph Carboni
- Department of Vascular Surgery, 26992University Hospital of Nice, France
| | - Elixène Jean-Baptiste
- Department of Vascular Surgery, 26992University Hospital of Nice, France.,439710Université Côte d'Azur, CHU, INSERM U1065, C3M, Nice, France
| | | | | | - Juliette Raffort
- 439710Université Côte d'Azur, CHU, INSERM U1065, C3M, Nice, France.,Clinical Chemistry Laboratory, 121283University Hospital of Nice, France
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