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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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Ramalho GNV, Dennison-Gibby S, Dancer S, Blacklock K, Cherbinsky O, Schechter A, Schwarz T. Computed tomographic features of suspected arterial pseudoaneurysm in the head and neck of four dogs. Vet Radiol Ultrasound 2024. [PMID: 39183521 DOI: 10.1111/vru.13427] [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: 12/28/2023] [Revised: 06/22/2024] [Accepted: 08/08/2024] [Indexed: 08/27/2024] Open
Abstract
Computed tomography is a valuable diagnostic technique in the clinical work-up of dogs with oropharyngeal trauma and bleeding. Traumatic extravasation can manifest as a pseudoaneurysm. A pseudoaneurysm is an extraluminal accumulation of blood that is contained by the adventitia layer or neighboring tissues. The purpose of this retrospective, multicenter, observational case series study was to describe the CT features in dogs with presumed oropharyngeal arterial pseudoaneurysm and its potential association with trauma. Imaging archives were searched for canine patients with head and neck CT studies showing visible extravasation of contrast-enhanced blood contained by soft tissue structures. Medical records of these patients were reviewed for oropharyngeal bleeding or trauma and reported. Four dogs met the inclusion criteria. CT findings included a well-defined, confined area of vascular contrast enhancement adjacent to the common carotid artery or its branches. The mean contrast enhancement in the corresponding artery and pseudoaneurysm lesion was similar, suggesting that these lesions represent active arterial extravasation. Four-dimensional CT was performed in one case and demonstrated contrast medium leaking from an artery and being contained by adjacent soft tissue structures. All dogs had a history and imaging findings consistent with oropharyngeal bleeding and trauma. Arterial pseudoaneurysm should be considered as a differential diagnosis in dogs with oral trauma and CT features of a well-defined, periarterial, strongly contrast-enhancing lesion.
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Affiliation(s)
- Goncalo N V Ramalho
- Royal (Dick) School of Veterinary Studies and Roslin Institute, The University of Edinburgh, Easter Bush Estate, Roslin, UK
| | | | - Sumari Dancer
- Royal (Dick) School of Veterinary Studies and Roslin Institute, The University of Edinburgh, Easter Bush Estate, Roslin, UK
| | - Kelly Blacklock
- Royal (Dick) School of Veterinary Studies and Roslin Institute, The University of Edinburgh, Easter Bush Estate, Roslin, UK
| | - Ofer Cherbinsky
- Atascadero Pet Hospital and Emergency Center, Atascadero, California, USA
| | - Aaron Schechter
- Atascadero Pet Hospital and Emergency Center, Atascadero, California, USA
| | - Tobias Schwarz
- Royal (Dick) School of Veterinary Studies and Roslin Institute, The University of Edinburgh, Easter Bush Estate, Roslin, UK
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Łajczak PM, Jóźwik K. Beyond the Band-Aid: Robot-Assisted Laparoscopy for Splenic Aneurysms. A Systematic Review. Ann Vasc Surg 2024:S0890-5096(24)00409-6. [PMID: 39009124 DOI: 10.1016/j.avsg.2024.05.026] [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: 04/12/2024] [Revised: 05/15/2024] [Accepted: 05/31/2024] [Indexed: 07/17/2024]
Abstract
INTRODUCTION Splenic artery aneurysm (SAA) is characterized by a weakening and bulging of splenic artery. Robot-assisted laparoscopic surgery is a minimally invasive surgical technique. This systematic review aimed to assess the use of robot-assisted laparoscopic surgery to manage SAA. METHODOLOGY Five medical databases were used to identify studies that investigated the use of robotic devices in laparoscopic SAA management in humans. Original, peer-reviewed articles were included. Two authors independently screened articles and extracted data on factors including patient demographics, surgical procedures, and outcomes. RESULTS The PRISMA search identified seven studies with a total of 28 patients who underwent robot-assisted laparoscopic surgery for SAA. The studies reported successful surgeries using various techniques, including end-to-end anastomosis, ligation, and graft placement. 3D printed models were used in one study as an aid for pre-operative surgery planning. Mean operation time was 210 minutes, and three complications were reported (robotic arm failure during surgery and two conversions to open surgery). DISCUSSION AND FUTURE DIRECTIONS Robot-assisted laparoscopic surgery offers several advantages over traditional open surgery for SAA management. However, more research is needed to confirm these potential benefits and establish robot-assisted laparoscopic surgery as a standard treatment option for SAA. Future studies should involve larger patient groups, compare this method to traditional techniques, and evaluate its cost-effectiveness. Additionally, incorporating advancements like mixed reality for pre-operative planning and 3D printing to improve surgical planning and patient communication.
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Affiliation(s)
- Paweł Marek Łajczak
- Prof. Zbigniew Religa Student Scientific Club at Department of Biophysics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Jordana 18, 40-043 Zabrze.
| | - Kamil Jóźwik
- Prof. Zbigniew Religa Student Scientific Club at Department of Biophysics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Jordana 18, 40-043 Zabrze
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Meyer NS, Ullrich L. Giant splenic artery pseudoaneurysm with arteriovenous fistula: diagnostic challenges and interdisciplinary treatment considerations. BMJ Case Rep 2024; 17:e259035. [PMID: 38991575 DOI: 10.1136/bcr-2023-259035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Abstract
We present a compelling case of an elderly male with a complex medical history who presented with sepsis secondary to a urinary tract infection. During admission, changes in his abdominal exam prompted imaging studies, which revealed a grade IV splenic laceration with a giant splenic artery pseudoaneurysm containing a suspected arteriovenous fistula component. Multidisciplinary discussion was had regarding patient management which resulted in the decision to perform an emergent splenectomy. Learning points from this case underscore the crucial role of interdisciplinary collaboration in the treatment of this pathology. Additionally, we discuss the decision-making process to support surgical intervention in the absence of clear guidelines in this exceedingly rare condition.
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Affiliation(s)
- Nathaniel Scott Meyer
- Medical Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Lauryn Ullrich
- St Luke's University Health Network, Bethlehem, Pennsylvania, USA
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Kawahara N, Tanizawa S, Morishita K. Rupture of a Splenic Artery Aneurysm With Gastric Perforation After Pancreaticoduodenectomy: A Case Report. Cureus 2024; 16:e64450. [PMID: 39135833 PMCID: PMC11317972 DOI: 10.7759/cureus.64450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2024] [Indexed: 08/15/2024] Open
Abstract
Splenic artery aneurysm (SAA) is the most common visceral artery aneurysm and can lead to severe outcomes if ruptured. This report presents the case of a 71-year-old female who experienced a sudden and severe gastrointestinal hemorrhage 19 years after undergoing pancreaticoduodenectomy for pancreatic head cancer. The patient arrived at the hospital with signs of shock, and imaging revealed an SAA rupture with associated gastric perforation. Emergency treatment involved endovascular techniques, which stabilized the patient and controlled the bleeding. This case highlights the importance of rapid diagnosis and the effectiveness of endovascular therapy in managing SAA rupture, particularly in patients with complex surgical histories.
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Affiliation(s)
- Naoki Kawahara
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, Tokyo, JPN
| | - Shu Tanizawa
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, Tokyo, JPN
| | - Koji Morishita
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, Tokyo, JPN
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6
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An TJ, Chen X, Omar OMF, Sutphin PD, Irani Z, Wehrenberg-Klee E, Iqbal S, Kalva SP. The Natural History of Splenic Artery Aneurysms: Factors That Predict Aneurysm Growth. J Vasc Interv Radiol 2024; 35:972-978. [PMID: 38663514 DOI: 10.1016/j.jvir.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 03/12/2024] [Accepted: 04/12/2024] [Indexed: 06/25/2024] Open
Abstract
PURPOSE To examine the natural history of splenic artery aneurysms (SAAs) at a single institution and assess the effect of patient factors and aneurysm characteristics on aneurysm growth. MATERIALS AND METHODS This single-center retrospective study included patients with SAAs who underwent serial imaging over 30 years (1990-2020). Data regarding patient demographics and aneurysm characteristics were collected. The variables contributing to aneurysm growth were assessed using nonparametric tests for continuous variables and chi-square test for categorical variables. Multivariable linear regression was performed using aneurysm growth rate as a continuous dependent variable. RESULTS A total of 132 patients were included in this study. The median maximum diameter of the SAAs was 15.8 mm (range, 4.0-50.0 mm). Growth over time was observed in 39% of the aneurysms, whereas the remaining 61% were stable in size. Of aneurysms that increased in size, the median aneurysm growth rate was 0.60 mm/y (range, 0.03-5.00 mm/y). Maximum aneurysm diameter of >2 cm and the presence of >50% mural thrombus were significant positive predictors for aneurysm growth (P = .020 and P = .022, respectively). Greater than 50% rim calcification was a significant negative predictor for aneurysm growth (P = .009) in multivariate analysis. CONCLUSIONS A larger baseline SAA size, presence of mural thrombus, and lack of rim calcification are associated with increased aneurysm growth rate.
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Affiliation(s)
- Thomas J An
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Xiaomin Chen
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Patrick D Sutphin
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Zubin Irani
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Eric Wehrenberg-Klee
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Shams Iqbal
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Sanjeeva P Kalva
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
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Salimi J, Nikraftar P, Rashidi F, Azimi M, Shokri A. Emergent method for management of splenic artery aneurysms rupture: A case report. Int J Surg Case Rep 2024; 116:109406. [PMID: 38432167 PMCID: PMC10943993 DOI: 10.1016/j.ijscr.2024.109406] [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: 01/08/2024] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 03/05/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Although endovascular therapy is becoming more used for the treatment of splenic artery aneurysms (SAAs) instead of open surgery, there is limited information available on the emergent hybrid approach, selectively. We present our experience of hybrid therapy using an emergent endovascular balloon for inflow control and open resection. CASE PRESENTATION A 34-year-old woman was brought to the emergency room after it was reported that she had a pseudoaneurysm in her splenic artery at a different medical facility. The patient was hemodynamically stable. Then we underwent a combination of endovascular and open procedures, using balloon proximal control and open aneurysm resection. She was discharged from hospital on the fifth postoperative day after the operation. CLINICAL DISCUSSION There is no agreement on how to treat SAA patients. Endovascular procedures such as endovascular intervention are also being used, minimizing the risks of surgery and shortening the patient's hospital stay, but complications remain. We propose to try SAA's emergency hybrid strategy operation with a good prognosis and fewer complications. CONCLUSION It seems that, compared to open surgery alone when endovascular procedures were impossible, elective hybrid procedures are more secure and efficient in stable patients and could make the operation easier without more dissection for proximal control of splenic artery.
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Affiliation(s)
- Javad Salimi
- Department of Vascular Surgery, Sina Hospital, Tehran University of Medical Science, Tehran, Iran.
| | - Parham Nikraftar
- Department of Vascular Surgery, Sina Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Fatemeh Rashidi
- Department of Vascular Surgery, Sina Hospital, Tehran University of Medical Science, Tehran, Iran; School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Azimi
- School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Amir Shokri
- Department of General Surgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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Patel RK, Chandel K, Tripathy T, Panigrahi MK, Behera S, Nayak HK, Pattnaik B, Dutta T, Gupta S, Patidar Y, Mukund A. Role of Interventional Radiology (IR) in vascular emergencies among cirrhotic patients. Emerg Radiol 2024; 31:83-96. [PMID: 37978126 DOI: 10.1007/s10140-023-02184-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/01/2023] [Indexed: 11/19/2023]
Abstract
Gastrointestinal hemorrhage remains one of the most common causes of morbidity and mortality among patients with liver cirrhosis. Mostly, these patients bleed from the gastroesophageal varices. However, nonvariceal bleeding is also more likely to occur in these patients. Because of frequent co-existing coagulopathy, cirrhotics are more prone to bleed from a minor vascular injury while performing percutaneous interventions. Ultrasound-guided bedside vascular access is an essential procedure in liver critical care units. Transjugular portosystemic shunts (TIPS) with/without variceal embolization is a life-saving measure in patients with refractory variceal bleeding. Whenever feasible, balloon-assisted retrograde transvenous obliteration (BRTO) is an alternative to TIPS in managing gastric variceal bleeding, but without a risk of hepatic encephalopathy. In cases of failed or unfeasible endotherapy, transarterial embolization using various embolic agents remains the cornerstone therapy in patients with nonvariceal bleeding such as ruptured hepatocellular carcinoma, gastroduodenal ulcer bleeding, and procedure-related hemorrhagic complications. Among various embolic agents, N-butyl cyanoacrylate (NBCA) enables better vascular occlusion in cirrhotics, even in coagulopathy, making it a more suitable embolic agent in an expert hand. This article briefly entails the different interventional radiological procedures in vascular emergencies among patients with liver cirrhosis.
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Affiliation(s)
- Ranjan Kumar Patel
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, India, 751019
| | - Karamvir Chandel
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, India, 751019
| | - Taraprasad Tripathy
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, India, 751019
| | - Manas Kumar Panigrahi
- Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, India, 751019
| | - Srikant Behera
- Department of General Medicine, All India Institute of Medical Sciences, Bhubaneswar, India, 751019
| | - Hemant Kumar Nayak
- Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, India, 751019
| | - Bramhadatta Pattnaik
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, India, 751019
| | - Tanmay Dutta
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, India, 751019
| | - Sunita Gupta
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, India, 751019
| | - Yashwant Patidar
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Amar Mukund
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India.
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Rai P, Kumar P, Verma PK, Agarwal K, Singh AK. Endoscopic Ultrasound-Guided Glue Embolization for Left Gastric Artery Pseudoaneurysm Presenting as Hemosuccus Pancreaticus After Failed Radiological Intervention. ACG Case Rep J 2024; 11:e01271. [PMID: 38371471 PMCID: PMC10871790 DOI: 10.14309/crj.0000000000001271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/02/2024] [Indexed: 02/20/2024] Open
Abstract
Hemosuccus pancreaticus is characterized by intermittent bleeding from the ampulla of Vater due to the rupture of a pseudoaneurysm. There are significant diagnostic and therapeutic challenges associated with this rare and potentially life-threatening condition. We present a rare case in an 18-year-old man who presented with recurrent episodes of hematemesis and melena due to hemosuccus pancreaticus as a result of a left gastric artery pseudoaneurysm. Initial radiological angioembolization failed because of median arcuate ligament syndrome, and endoscopic ultrasound-guided glue embolization was successfully performed. This case further reinforces the importance of endoscopic ultrasound-guided therapy in the management of pseudoaneurysm after failed radiological treatment.
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Affiliation(s)
- Praveer Rai
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Pankaj Kumar
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Prabhat Kumar Verma
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kartik Agarwal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anil Kumar Singh
- Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Yang Y, Liu XM, Li HP, Xie R, Tuo BG, Wu HC. Pancreatic pseudoaneurysm mimicking pancreatic tumor: A case report and review of literature. World J Gastrointest Oncol 2023; 15:2041-2048. [DOI: 10.4251/wjgo.v15.i11.2041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/04/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Pancreatic pseudoaneurysm is a rare vascular complication of chronic pancreatitis (CP) or necrotizing pancreatitis with an incidence of 4% to 17%, but it is potentially life-threatening. It is well known that most pancreatic pseudoaneurysms are clinically associated with pancreatic pseudocysts and are usually in the peripancreatic body-tail. A minority of intrapancreatic pseudoaneurysms occur in the absence of pseudocyst formation. Noninvasive computed tomography (CT) and magnetic resonance imaging (MRI) are most commonly used examinations for screening pancreatic pseudoaneurysms. Notably, the rare intrapancreatic pseudoaneurysm in the pancreatic head can mimic a hypervascular solid mass and be misdiagnosed as a pancreatic tumor.
CASE SUMMARY We report the case of a 67-year-old man who had been admitted to our hospital due to recurrent abdominal pain for 1 mo that was aggravated for 5 d. CT and MRI revealed a mass in the pancreatic head with significant expansion of the main pancreatic duct and mild atrophy of the pancreatic body-tail. He was admitted to the department of hepatobiliary and pancreatic surgery due to the possibility of a pancreatic tumor. The patient was then referred for endoscopic ultrasonography (EUS) with possible EUS-FNA. However, EUS showed a cystic lesion in the pancreatic head with wall thickness and enhancing nodules, which was doubtful because it was inconsistent with the imaging findings. Subsequently, color doppler flow imaging demonstrated turbulent arterial blood flow in the cystic lesion and connection with the surrounding vessel. Therefore, we highly suspected the possibility of CP complicated with intrapancreatic pseudoaneurysm, combined with the patient's long-term drinking history and the sonographic features of CP. Indeed, angiography revealed an oval area of contrast medium extravasation (size: 1.0 cm × 1.5 cm) at the far-end branch of the superior pancreaticoduodenal artery, and angiographic embolization was given immediately at the same time.
CONCLUSION EUS is an important differential diagnostic tool when pancreatic pseudoaneurysm mimics the imaging appearance of a hypervascular pancreatic tumor.
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Affiliation(s)
- Yuan Yang
- Department of Gastroenterology, Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Xue-Mei Liu
- Department of Gastroenterology, Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Hong-Ping Li
- Department of Gastroenterology, Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Rui Xie
- Department of Gastroenterology, Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Bi-Guang Tuo
- Department of Gastroenterology, Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Hui-Chao Wu
- Department of Gastroenterology, Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
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Iftekhar W, Shaikh FA, Jamil N, Shaikh H. Managing Splenic Artery Pseudoaneurysms-An Experience from a Developing Country. A Retrospective Review. Ann Vasc Dis 2023; 16:195-199. [PMID: 37779655 PMCID: PMC10539133 DOI: 10.3400/avd.oa.22-00114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 06/30/2023] [Indexed: 10/03/2023] Open
Abstract
Objectives: Splenic artery pseudoaneurysm is a rare but potentially fatal condition. Early diagnosis and intervention are the key steps in the management of this condition. We have reviewed our institution's 4-year data regarding the presentation and management of this condition. Methods: We conducted a prospective review of the records of 10 patients who presented to our institute from January 2018 to December 2021 with a splenic artery pseudoaneurysm. We found one patient with a true aneurysm, whom we excluded from the study. Results: This study included seven male and two female patients with a mean age of 47.7 years. Six patients presented to the emergency department with bleeding secondary to rupture aneurysm, which is the most common reason for admission. Pancreatitis was found to be the most common cause for splenic artery pseudoaneurysm (five patients). Computed tomography angiogram remained the modality of choice for diagnosing splenic artery pseudoaneurysm. All patients were successfully managed with endovascular intervention. Conclusion: Splenic artery pseudoaneurysm is usually a rare complication of pancreatitis, which is associated with high morbidity and mortality. Timely diagnosis and intervention are the keys to successful management. Endovascular embolization should be the first-line therapy in splenic artery pseudoaneurysm.
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Affiliation(s)
- Wafa Iftekhar
- Department of Surgery, Agha Khan University Hospital, Karachi, Pakistan
| | - Fareed Ahmed Shaikh
- Department of Vascular Surgery, Agha Khan University Hospital, Karachi, Pakistan
| | - Nida Jamil
- Department of Surgery, Mayo University Hospital, County Mayo, Ireland
| | - Hafsa Shaikh
- Department of Surgery, Agha Khan University Hospital, Karachi, Pakistan
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12
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Chahrour H, Chaaban A, Amado A, Hindi H, Harb A. Acute presentation of renal pseudoaneurysms in a patient with systemic lupus erythematosus after percutaneous renal biopsy. Radiol Case Rep 2023; 18:2935-2938. [PMID: 37383177 PMCID: PMC10293586 DOI: 10.1016/j.radcr.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/05/2023] [Indexed: 06/30/2023] Open
Abstract
The development of renal pseudoaneurysms following percutaneous kidney biopsy is a rare but potentially dangerous complication due to the risk of rupture with subsequent hemorrhage. We describe a female patient in her 20s with long-standing lupus nephritis who presented to the hospital for elective CT-guided left renal biopsy that was complicated by pseudoaneurysms in the bilateral kidneys. Post-biopsy, she developed a perinephric hematoma that extended to the upper pelvis with resultant superior displacement and diminished blood flow to the left kidney. Successful endovascular coil embolization was performed after left renal artery angiography confirmed contrast extravasation in one of the branches that supplied the inferior pole of the left kidney. Despite the embolization, her hemoglobin continued to decline, and a subsequent CT-scan demonstrated a persistent loculated hyperdense fluid collection in the beforementioned area. Repeat angiography revealed multiple left renal pseudoaneurysms and a single pseudoaneurysm in the upper pole of the right kidney, neither of which were previously visualized. The acute development of pseudoaneurysms due to accidental or non-accidental trauma is a well-established entity. Here we present a patient that acutely developed numerous arterial pseudoaneurysms after renal biopsy and has never been reported in the literature. Special caution should be undertaken in the case of high-risk patients predisposed to these pseudoaneurysms.
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Affiliation(s)
- Hussein Chahrour
- Detroit Medical Center, Diagnostic Radiology, 4201 St Antoine, Detroit, MI, 48201, USA
- Wayne State University, Diagnostic Radiology, 4100 John R St, Detroit, MI 48201, USA
| | - Ahmed Chaaban
- Wayne State University, Diagnostic Radiology, 4100 John R St, Detroit, MI 48201, USA
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Adam Amado
- Detroit Medical Center, Diagnostic Radiology, 4201 St Antoine, Detroit, MI, 48201, USA
- Wayne State University, Diagnostic Radiology, 4100 John R St, Detroit, MI 48201, USA
| | - Hussam Hindi
- Detroit Medical Center, Diagnostic Radiology, 4201 St Antoine, Detroit, MI, 48201, USA
- Wayne State University, Diagnostic Radiology, 4100 John R St, Detroit, MI 48201, USA
| | - Ali Harb
- Detroit Medical Center, Diagnostic Radiology, 4201 St Antoine, Detroit, MI, 48201, USA
- Wayne State University, Diagnostic Radiology, 4100 John R St, Detroit, MI 48201, USA
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Khurana AT, Chittajallu V, Reed S, Sutter C, Glessing B. Lumbar Artery Pseudoaneurysms Presenting as a Novel Complication of Severe, Necrotizing Pancreatitis. ACG Case Rep J 2023; 10:e01129. [PMID: 37621303 PMCID: PMC10445782 DOI: 10.14309/crj.0000000000001129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/20/2023] [Indexed: 08/26/2023] Open
Abstract
Splanchnic artery pseudoaneurysms are a known complication of necrotizing pancreatitis. Lumbar artery pseudoaneurysms are rare and usually associated with trauma, renal biopsy, or spinal procedures. We present a rare case of lumbar artery pseudoaneurysms as a complication of necrotizing pancreatitis. A 55-year-old man initially presented with necrotizing biliary pancreatitis complicated by peripancreatic necrotic fluid collections and walled-off necrosis requiring multiple endoscopic ultrasound-guided necrosectomies. Inferoposterior extension of collections to the retroperitoneum caused lumbar artery pseudoaneurysms, leading to hemorrhagic shock from retroperitoneal and intraperitoneal hemorrhages.
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Affiliation(s)
- Akash T. Khurana
- Department of Internal Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH
- Department of Medicine, Case Western Reserve University, Cleveland, OH
| | - Vibhu Chittajallu
- Department of Medicine, Case Western Reserve University, Cleveland, OH
- Digestive Health Institute, University of Hospitals Cleveland Medical Center, Cleveland, OH
| | - Steven Reed
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Christopher Sutter
- Department of Medicine, Case Western Reserve University, Cleveland, OH
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Brooke Glessing
- Department of Medicine, Case Western Reserve University, Cleveland, OH
- Digestive Health Institute, University of Hospitals Cleveland Medical Center, Cleveland, OH
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14
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Fukamatsu F, Sugiura K, Takekoshi D, Fukuzawa T, Oyama K, Tsukahara Y, Kurozumi M, Shimizu A, Fujinaga Y. A ruptured splenic artery aneurysm treated by transcatheter arterial embolization using n-butyl cyanoacrylate-Lipiodol-Iopamidol. Radiol Case Rep 2023; 18:2385-2390. [PMID: 37179814 PMCID: PMC10172629 DOI: 10.1016/j.radcr.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/25/2023] [Accepted: 04/03/2023] [Indexed: 05/15/2023] Open
Abstract
N-butyl cyanoacrylate, one of embolic materials, is usually used as a mixture with Lipiodol (N-butyl cyanoacrylate-Lipiodol mixture). N-butyl cyanoacrylate-Lipiodol-Iopamidol was developed by adding a nonionic iodine contrast agent (Iopamiron) to N-butyl cyanoacrylate-Lipiodol mixture. N-butyl cyanoacrylate-Lipiodol-Iopamidol has lower adhesiveness than N-butyl cyanoacrylate-Lipiodol mixture and the ability to form a single large droplet. We report the case of a 63-year-old man with a ruptured splenic artery aneurysm treated by transcatheter arterial embolization using N-butyl cyanoacrylate-Lipiodol-Iopamidol. He was referred to the emergency room because of sudden onset of upper abdominal pain. A diagnosis was established using contrast-enhanced computed tomography and angiography. Emergency transcatheter arterial embolization was performed, and the ruptured splenic artery aneurysm was successfully embolized using a combination of coil framing and N-butyl cyanoacrylate-Lipiodol-Iopamidol packing. This case demonstrates the usefulness of a combination of coil framing and N-butyl cyanoacrylate-Lipiodol-Iopamdol packing for the embolization of aneurysms.
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Affiliation(s)
- Fumiaki Fukamatsu
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
- Corresponding author.
| | - Kazusa Sugiura
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Daiya Takekoshi
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Takuya Fukuzawa
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Kazuki Oyama
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Yoshinori Tsukahara
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Masahiro Kurozumi
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Akira Shimizu
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Yasunari Fujinaga
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
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15
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Chooklin S, Chuklin S, Posivnych M, Krystopchuk S. Hemosuccus pancreaticus as a rare cause of gastrointestinal bleeding. EMERGENCY MEDICINE 2023; 19:58-69. [DOI: 10.22141/2224-0586.19.2.2023.1559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Hemosuccus pancreaticus is a life-threatening condition that should be considered in patients with abdominal pain, gastrointestinal hemorrhage and high serum amylase. The varied presentation of hemosuccus pancreaticus and the limited literature evidence due to its rarity make it challenging to diagnose. Diagnostic modalities include contrast-enhanced computed tomography scans, endoscopic procedures (esophagoduodenoscopy and endoscopic retrograde cholangiopancreatography) and angiography. Therapeutic management through an interventional radiology using coil embolization is safe and effective in hemodynamically stable patients with hemosuccus pancreaticus. Endosonography can be an innovative approach for the diagnosis and treatment of patients in whom contrast cannot be administered; however, its safety and efficacy need to be confirmed by future studies. This review presents current views on the diagnosis and treatment of patients with hemosuccus pancreaticus.
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16
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Iacobellis F, Schillirò ML, Di Serafino M, Borzelli A, Grimaldi D, Verde F, Caruso M, Dell'Aversano Orabona G, Rinaldo C, Sabatino V, Cantisani V, Vallone G, Romano L. Multimodality ultrasound assessment of the spleen: Normal appearances and emergency abnormalities. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:543-559. [PMID: 36515988 DOI: 10.1002/jcu.23414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 06/17/2023]
Abstract
This paper summarizes the main splenic emergencies and their ultrasonographic findings to orient appropriate patient management. US requires minimal preparation time and allows to examine the parenchyma and to detect intraperitoneal fluid collections, which may be indirect evidence of solid organ injuries. In this paper, we analyze the role of B-mode, Doppler and Contrast-Enhanced Ultrasound in the diagnosis of splenic emergencies, with a particular focus on splenic infarction, infection, traumatic injuries and vascular splenic anomalies.
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Affiliation(s)
- Francesca Iacobellis
- Department of General and Emergency Radiology "Antonio Cardarelli" Hospital, Naples, Italy
| | - Maria Laura Schillirò
- Department of General and Emergency Radiology "Antonio Cardarelli" Hospital, Naples, Italy
| | - Marco Di Serafino
- Department of General and Emergency Radiology "Antonio Cardarelli" Hospital, Naples, Italy
- Department of Life and Health, University of Molise "V. Tiberio2, Campobasso, Italy
| | - Antonio Borzelli
- Department of Interventional Radiology "Antonio Cardarelli" Hospital, Naples, Italy
| | - Dario Grimaldi
- Department of General and Emergency Radiology "Antonio Cardarelli" Hospital, Naples, Italy
| | - Francesco Verde
- Department of General and Emergency Radiology "Antonio Cardarelli" Hospital, Naples, Italy
| | - Martina Caruso
- Department of General and Emergency Radiology "Antonio Cardarelli" Hospital, Naples, Italy
| | | | - Chiara Rinaldo
- Department of General and Emergency Radiology "Antonio Cardarelli" Hospital, Naples, Italy
| | - Vittorio Sabatino
- Department of General and Emergency Radiology "Antonio Cardarelli" Hospital, Naples, Italy
| | - Vito Cantisani
- Department of Radiology, Sapienza Rome University, Rome, Italy
| | - Gianfranco Vallone
- Department of Life and Health, University of Molise "V. Tiberio2, Campobasso, Italy
| | - Luigia Romano
- Department of General and Emergency Radiology "Antonio Cardarelli" Hospital, Naples, Italy
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Gastrointestinal Bleeding Secondary to Splenic Artery Pseudoaneurysm: A Delayed Complication of a Lumen-Apposing Metal Stent. ACG Case Rep J 2023; 10:e01001. [PMID: 36891184 PMCID: PMC9988280 DOI: 10.14309/crj.0000000000001001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 02/03/2023] [Indexed: 03/06/2023] Open
Abstract
Lumen-apposing metal stents (LAMSs) have been widely used for drainage of peripancreatic collections. A 71-year-old woman with a history of necrotizing pancreatitis who underwent LAMS placement 3 months ago for symptomatic pancreatic fluid collection presented with hematochezia and hemodynamic instability. Computed tomographic angiography of the abdomen showed concerns for stent erosion into the splenic artery. Esophagogastroduodenoscopy revealed a large pulsating nonbleeding vessel within the LAMS. She underwent a mesenteric angiogram, which showed splenic artery pseudoaneurysm, and coil embolization was performed. Gastrointestinal bleeding secondary to pseudoaneurysm should be considered in patients with recent LAMS placement who present with signs of gastrointestinal bleeding.
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Okumura T, Kimura T, Nakajima D, Kondo S, Kako S, Takahashi Y, Yamaka K, Ichinohe F, Tsukahara Y, Nagaya T, Umemura T. Splenic artery pseudoaneurysm resulting from gastric ulcer presenting acute upper gastrointestinal bleeding. Radiol Case Rep 2022; 18:97-99. [PMID: 36324839 PMCID: PMC9619333 DOI: 10.1016/j.radcr.2022.09.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 09/28/2022] [Indexed: 11/07/2022] Open
Abstract
Splenic artery pseudoaneurysm (SAP) is a rare entity, which occurs when the arterial wall is composed only of the intima and media mainly caused by pancreatitis, or abdominal trauma. Regardless of size, SAP is a high mortality disease that carries a high risk of rupture, causing abdominal pain and severe pancreatic and gastrointestinal bleeding. Here, we describe a rare case of SAP rupture caused by a large gastric ulcer due to Helicobacter pylori infection and NSAIDs use. Understanding the characteristic enhanced CT images of SAP, the complications of splenic infarction, and the therapeutic efficacy of arterial embolization is essential for the clinician to properly diagnose and treat SAP.
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Affiliation(s)
- Taiki Okumura
- Division of Gastroenterology and Hepatology, Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takefumi Kimura
- Division of Gastroenterology and Hepatology, Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan
- Consultation Center for Liver Diseases, Shinshu University Hospital, Matsumoto, Japan
- Corresponding author
| | - Daichi Nakajima
- Division of Gastroenterology and Hepatology, Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shohei Kondo
- Division of Gastroenterology and Hepatology, Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Satoko Kako
- Division of Gastroenterology and Hepatology, Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yoshiyuki Takahashi
- Division of Gastroenterology and Hepatology, Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kosuke Yamaka
- Division of Nephrology, Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Fumihito Ichinohe
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yoshinori Tsukahara
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tadanobu Nagaya
- Division of Gastroenterology and Hepatology, Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takeji Umemura
- Division of Gastroenterology and Hepatology, Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan
- Consultation Center for Liver Diseases, Shinshu University Hospital, Matsumoto, Japan
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19
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Survival following devastating penetrating gunshots polytrauma with grade 5 liver injuries requiring multiple massive transfusion protocols: A case report and review of the literature. Int J Surg Case Rep 2022; 98:107608. [PMCID: PMC9468388 DOI: 10.1016/j.ijscr.2022.107608] [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: 08/16/2022] [Revised: 08/31/2022] [Accepted: 09/03/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction A devastating injury to the liver from a gunshot wound (GSW) challenges the most seasoned trauma surgeon. This challenge is intensified when patients develop severe shock with a high-grade injury. We present the case of a patient with a grade 5 liver injury after a GSW treated with operative and interventional radiology (IR) treatment simultaneously. Case presentation A 25-year-old male presented to our Trauma Center with hypotension, after an abdominal GSW. He was taken emergently to the operating room, which revealed a Grade 5 liver injury with massive hemorrhage. Operative intervention was initiated immediately and a non-anatomic left lobectomy with hepatorrhaphy was performed. IR was consulted intra-operatively and performed a left hepatic artery angioembolization. The patient received over 50 units of blood products during the combined procedures, with eventual bleeding control. On post-operative day 33, the patient became acutely hemodynamically unstable, and angiography revealed a splenic artery pseudoaneurysm, which was embolized but re-bled and resulted in splenectomy. The patient eventually recovered and follows up at 1-year revealed a patient doing well. Discussion High-grade liver injuries carry significant mortality. Mortality worsens when severe shock is present. Operative intervention is the standard approach for patients who remain in shock. To help improve outcomes patients may benefit from a combined approach with the interventional radiology team. Conclusion The acute management of severe liver injuries when presenting with ongoing shock is beneficial to include both trauma surgeons with interventional radiologists. Further studies are needed to determine the best approach for this devastating injury. Severe hepatic injuries may require both operative management & angioembolization. Class 4 hemorrhagic shock often requires a massive transfusion protocol. Algorithms for operative/angiographic treatment of liver/spleen injuries are needed. Delayed hemorrhage after angioembolization for splenic pseudoaneurysm can occur.
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20
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Hussein MM, Al-Mollah M, Kanaan T. Splenic artery aneurysm rupture post-anterior cervical discectomy and fusion: Case report & literature review. Int J Surg Case Rep 2022; 99:107704. [PMID: 36261936 PMCID: PMC9568878 DOI: 10.1016/j.ijscr.2022.107704] [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: 09/03/2022] [Revised: 09/22/2022] [Accepted: 09/24/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction and importance Anterior cervical discectomy and fusion (ACDF) is a regular surgical procedure for correcting spinal deformities and pain relief. There are several rare complications of ACDF, one of which is postoperative hematomas. Here, we report an unexpected case of intra-abdominal hematoma after ACDF with no prior abdominal symptoms or underlying conditions identified since admission. This report will describe the events and interventions that took place for this patient. Case description The patient is a 44-year-old female with a history of neck pain of four-month duration. On Magnetic Resonance Imaging (MRI), a degenerative cervical disk (C5-C6) was identified. Prior surgical history is significant for a C4-C5 ACDF 3 years ago. An anterior cervical discectomy and fusion was performed and the patient was doing well relatively post-surgery. However, in less than 24 h, the patient complained of severe abdominal pain. An abdominal Computerized topography angiogram (CTA) scan revealed internal bleeding and a splenic aneurysm rupture. The patient immediately underwent an urgent laparotomy and splenectomy. Clinical discussion Splenic artery aneurysm incidence is rare and is detected incidentally by imaging technology in asymptomatic patients or upon rupture. Splenic artery aneurysm rupture can be spontaneous and unpredictable in previously undiagnosed patients leading to life-threatening symptoms of intra-abdominal hemorrhage. Conclusion Patients undergoing ACDF should be monitored closely following surgery for any complications. Physicians should consider the possibility of any signs of hematoma due to underlying conditions that are undiagnosed in order to treat accordingly. Unexpected case of intra-abdominal hematoma post-anterior cervical discectomy and fusion (ACDF) due to splenic artery aneurysm. True splenic artery aneurysms (SAA) are rare but potentially fatal, they are the third most common abdominal aneurysms. As much as 80% of cases of splenic artery aneurysms are asymptomatic. Surgical patients should be evaluated prior to operations and post-operative monitoring should be performed to prevent/treat complications.
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Affiliation(s)
- Moaiad Mohammed Hussein
- Division of Neurosurgery, Department of Special Surgery, University of Jordan, Amman, Jordan.
| | - Mustafa Al-Mollah
- Division of Neurosurgery, Department of Special Surgery, University of Jordan, Amman, Jordan.
| | - Tariq Kanaan
- Division of Neurosurgery, Department of Special Surgery, University of Jordan, Amman, Jordan
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21
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Singh A, Makhija N, Somani S, Verma M, Kumar S. Splenic Artery Pseudoaneurysm—A Concern for the Anesthesiologist. JOURNAL OF CARDIAC CRITICAL CARE TSS 2022. [DOI: 10.1055/s-0042-1756472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
AbstractPseudoaneurysms as compared with aneurysms lack a true wall and have a higher propensity of rupture. Visceral artery pseudoaneurysms are uncommon and are life-threatening. We, hereby, report anesthetic management of a rare case of splenic artery pseudoaneurysm that accompanied the dilatation of aorta from its origin extending up to its bifurcation.
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Affiliation(s)
- Ankita Singh
- Department of Cardiac Anaesthesia & Critical Care, Cardiothoracic Centre, CNC, All India Institute of Medical Sciences, New Delhi, India
| | - Neeti Makhija
- Department of Cardiac Anaesthesia & Critical Care, Cardiothoracic Centre, CNC, All India Institute of Medical Sciences, New Delhi, India
| | - Shruti Somani
- Department of Cardiac Anaesthesia & Critical Care, Cardiothoracic Centre, CNC, All India Institute of Medical Sciences, New Delhi, India
| | - Mansi Verma
- Department of Cardiovascular Radiology & Endovascular Interventions, Cardiothoracic Centre, CNC, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology & Endovascular Interventions, Cardiothoracic Centre, CNC, All India Institute of Medical Sciences, New Delhi, India
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22
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Abstract
BACKGROUND Recent studies have shown that non-operative management of patients with splenic injury has up to a 90% success rate. However, delayed hemorrhage secondary to splenic artery pseudoaneurysm occurs in 5-10% of patients with up to 27% of patients developing a pseudoaneurysm on delayed imaging. The goal of our study was to evaluate the safety and utility of delayed CT imaging for blunt splenic injury patients. METHODS A retrospective evaluation of all traumatic splenic injuries from 2018 to 2020 at a single level 1 trauma center was undertaken. Patients were sub-divided into 4 groups based on the extent of splenic injury: Grades I-II, Grade III, Grade IV, and Grade V. Patient injury characteristics along with hospital length of stay, imaging, procedures, and presence/absence of pseudoaneurysm were documented. RESULTS 588 trauma patients were initially included for evaluation with 539 included for final analysis. 297 patients sustained Grades I-II, 123 Grade III, 61 Grade IV, and 58 Grade V splenic injuries. 129 patients (24%) underwent either emergent or delayed (>6 hours) splenectomy with an additional 6 patients having a splenorrhaphy on initial operation. Of the patients who were treated non-operatively, 98% of Grade III, 91% of Grade IV, and 100% of Grade V splenic injury patients underwent follow up CT imaging. The mean time from admission to follow-up abdominal CT scan was 5 ± 4.4 days. 22 pseudoaneurysms were identified including 10/84 Grade III, 7/22 Grade IV, and 2/5 Grade V; of these patients 33% Grade III and 30% Grade IV required subsequent splenectomy. CONCLUSIONS Routine follow up CT imaging after high grade splenic injury identifies splenic artery pseudoaneurysm in a significant proportion of patients. Standardized surveillance imaging for high grade splenic trauma promotes prospective identification of pseudoaneurysms, allowing for interventions to minimize delayed splenic injury complications. LEVEL OF EVIDENCE Level 4; therapeutic.
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23
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Cao Y, Song S, Ouyang T, Zheng C. Single-Center Experience With Endovascular Treatment for Splenic Artery Aneurysms in Long-Term Follow-Up: A Retrospective Study. Front Cardiovasc Med 2022; 8:793053. [PMID: 35155605 PMCID: PMC8831690 DOI: 10.3389/fcvm.2021.793053] [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: 10/11/2021] [Accepted: 12/24/2021] [Indexed: 11/28/2022] Open
Abstract
Objectives To reveal a single-center experience with endovascular treatment for splenic artery aneurysm (SAA) and analyze the safety and efficacy of the operation in the long-term follow-up. Materials and Methods A total of 49 patients with SAAs (21 men, 28 women; mean age, 52.4 ± 11.5 years) were enrolled in this study from July 2010 to December 2020. Baseline and characteristics of SAAs were collected. Parent artery coil embolization or combined with sac coil embolization of SAAs, graft-stent implantation, or bare-stent-assisted coil embolization were performed for the treatment of SAAs. Adverse events and follow-up data were recorded. Results The average diameter of SAAs was 3.3 ± 2.5 cm (range, 1.0–13.6 cm). An individual-tailed modality was conducted for three patients. A 100% technical success rate was achieved. No re-intervention procedure was performed in all patients. No major treatment-related adverse events were observed, and no expansion or rupture of SAAs occurred in the average follow-up period of 57.9 ± 27.3 months (19–125 months). Conclusion Endovascular treatment of SAA, including the individual-tailed therapy for three cases, is safe, effective, and minimally invasive with high technical success rates and satisfactory outcomes during the long-term follow-up period.
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Affiliation(s)
- Yanyan Cao
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Songlin Song
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Tao Ouyang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Chuansheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
- *Correspondence: Chuansheng Zheng
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24
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Jenkins P, MacCormick A, Stokes J, Lyall F, Rogers A, Gafoor N. Learning from mistakes when reporting urgent and emergency vascular studies. Clin Radiol 2021; 77:159-166. [PMID: 34903386 DOI: 10.1016/j.crad.2021.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/13/2021] [Indexed: 02/07/2023]
Abstract
The majority of out-of-hours cases relate to neurological, chest, and gastrointestinal pathologies with acute vascular cases being encountered less commonly. Trainees and exposure of non-vascular/interventional radiology (IR) consultants to angiographic imaging is often limited in working hours and this may lead to reporting on-call cases outside of normal daytime practice. In a recent local review, a number on-call vascular studies were found to contain a number of vascular-related discrepancies. Vascular reporting is a complex subspecialty, which comprises many clear diagnoses (large vessel occlusions, large vessel aneurysms, or dissections); however, also several subtle and complex abnormalities. These more subtle abnormalities, at times, require dedicated vascular specialist review to ensure subtle findings are communicated appropriately to the clinical team. The recent increased complexity of endovascular treatments and their complications has also provided further challenge for the non-specialist reporter. Similarly, improved imaging techniques have allowed for non-obvious but significant findings that may require urgent management, such as small aneurysms and dissection flaps. We will review a range of key vascular findings that demonstrate learning opportunities, particularly within the acute and on-call settings. These will include gastrointestinal haemorrhage, subtle aortic pathologies, head and neck vascular emergencies, small to mid-sized vessel injuries and imaging of post-procedural complications. Educational hints and tips will be provided to enable learning from mistakes encountered by trainees and non-vascular specialist radiologists in the on-call or urgent reporting settings, and these will be reviewed with reference to the literature.
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Affiliation(s)
- P Jenkins
- Peninsula Radiology Academy, Plymouth, UK.
| | | | - J Stokes
- Department of Neuroradiology, University of Plymouth Hospitals NHS Trust, Plymouth, UK
| | - F Lyall
- Peninsula Radiology Academy, Plymouth, UK
| | - A Rogers
- Department of Radiology, Royal Cornwall NHS Trust, Cornwall, UK
| | - N Gafoor
- Department of Interventional Radiology, University of Plymouth Hospitals NHS Trust, Plymouth, UK
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25
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Salimi J, Foroutani L, Miratashi Yazdi SA. Management of huge splenic artery aneurysm with new hybrid procedure including endovascular and open surgical approach: Case series. Int J Surg Case Rep 2021; 89:106585. [PMID: 34775324 PMCID: PMC8593227 DOI: 10.1016/j.ijscr.2021.106585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/04/2021] [Accepted: 11/09/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Splenic artery aneurysms (SAAs) account for more than half of all visceral artery aneurysms. Small SAAs are usually asymptomatic, but giant aneurysms are more likely to cause symptoms and result in life-threatening complications; these aneurysms treatment can be challenging. Splenic artery aneurysms treatment includes laparotomy, laparoscopy, or endovascular techniques. CASE PRESENTATION This case series reports the details of successful management of three patients with huge splenic artery aneurysms who underwent hybrid surgery, endovascular inflow control with a balloon, and open aneurysm resection. DISCUSSION Although endovascular treatment options are increasingly favored, only selected aneurysms are suitable for these procedures, as marked tortuosity of the artery or SAA in the proximal splenic artery may not be suitable for endovascular management. CONCLUSION Open surgery escorted by endovascular techniques can be considered an ideal treatment of SAA in the proximal region of the splenic artery.
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Affiliation(s)
- Javad Salimi
- Professor of Surgery, Vascular & Endovascular Surgeon, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Lale Foroutani
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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26
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Hu T, Oda M, Hayashi Y, Lu Z, Kumamaru KK, Akashi T, Aoki S, Mori K. Aorta-aware GAN for non-contrast to artery contrasted CT translation and its application to abdominal aortic aneurysm detection. Int J Comput Assist Radiol Surg 2021; 17:97-105. [PMID: 34674136 DOI: 10.1007/s11548-021-02492-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 09/03/2021] [Indexed: 01/01/2023]
Abstract
PURPOSE Artery contrasted computed tomography (CT) enables accurate observations of the arteries and surrounding structures, thus being widely used for the diagnosis of diseases such as aneurysm. To avoid the complications caused by contrast agent, this paper proposes an aorta-aware deep learning method to synthesize artery contrasted CT volume form non-contrast CT volume. METHODS By introducing auxiliary multi-resolution segmentation tasks in the generator, we force the proposed network to focus on the regions of aorta and the other vascular structures. Then, the segmentation results produced by the auxiliary tasks were used to extract aorta. The detection of abnormal CT images containing aneurysm was implemented by estimating the maximum axial radius of aorta. RESULTS In comparison with the baseline models, the proposed network with auxiliary tasks achieved better performances with higher peak signal-noise ratio value. In aorta regions which are supposed to be the main region of interest in many clinic scenarios, the average improvement can be up to 0.33dB. Using the synthesized artery contrasted CT, the F score of aneurysm detection achieved 0.58 at slice level and 0.85 at case level. CONCLUSION This study tries to address the problem of non-contrast to artery contrasted CT modality translation by employing a deep learning model with aorta awareness. The auxiliary tasks help the proposed model focus on aorta regions and synthesize results with clearer boundaries. Additionally, the synthesized artery contrasted CT shows potential in identifying slices with abdominal aortic aneurysm, and may provide an option for patients with contrast agent allergy.
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Affiliation(s)
- Tao Hu
- Graduate School of Informatics, Nagoya University, Chikusa-ku, Nagoya, Aichi, Japan
| | - Masahiro Oda
- Graduate School of Informatics, Nagoya University, Chikusa-ku, Nagoya, Aichi, Japan
- Information Strategy Office, Information and Communications, Nagoya University, Chikusa-ku, Nagoya, Aichi, Japan
| | - Yuichiro Hayashi
- Graduate School of Informatics, Nagoya University, Chikusa-ku, Nagoya, Aichi, Japan
| | - Zhongyang Lu
- Graduate School of Informatics, Nagoya University, Chikusa-ku, Nagoya, Aichi, Japan
| | | | - Toshiaki Akashi
- Department of Radiology, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Kensaku Mori
- Graduate School of Informatics, Nagoya University, Chikusa-ku, Nagoya, Aichi, Japan.
- Research Center for Medical Bigdata, National Institute of Informatics, Chiyoda-ku, Tokyo, Japan.
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27
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Johal M, Kalaravy M, Ali F, Barve R, Ahmed A, Francis CT, Harky A. Evolving Diagnostic and Therapeutic Options for Visceral Artery Aneurysms. Ann Vasc Surg 2021; 76:488-499. [PMID: 33823252 DOI: 10.1016/j.avsg.2021.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/09/2021] [Accepted: 03/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Visceral artery aneurysms (VAAs) are associated with a very high mortality rate when ruptured and may present as a surgical emergency. Due to their rarity and varying pathophysiology, literature concerning the optimal management of VAAs is limited. This review evaluates the evolving management options for VAAs with a focus on open and endovascular repair. METHODS A combination of databases including OVID, PubMed and Medline were used to perform a literature search. Search terms employed include 'visceral artery aneurysms', 'angiography', '3D-volumetric rendering', 'management', 'open repair' and 'endovascular repair', amongst others. RESULTS 3D modelling in conjunction with existing diagnostic techniques, such as computed tomography and angiography, may improve diagnostic sensitivity. The literature surrounding operative management of VAAs highlights the effectiveness of endovascular repair for anatomically suitable aneurysms. Advances in endovascular technologies may expand the type and number of aneurysms amenable to catheter-based treatment approaches. For aneurysms not amenable to endovascular treatment, or those with an emergency indication, open repair remains an appropriate management choice. CONCLUSION Although rare, VAAs pose a high mortality risk, especially when ruptured. Practical limitations that restrict current operative approaches may be overcome by recent developments including novel neurointerventional techniques that have been applied in VAA management.
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Affiliation(s)
- Monika Johal
- Imperial College School of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Mayurey Kalaravy
- Imperial College School of Medicine, Faculty of Medicine, Imperial College London, London, UK; Guy's, King's and St Thomas' School of Medicine, King's College London, London, UK
| | - Fahad Ali
- Imperial College School of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Rajas Barve
- Imperial College School of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Amna Ahmed
- Imperial College School of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Chris T Francis
- Department of Vascular Surgery, Countess of Chester Hospital, Chester, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.
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28
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Talwar A, Knight G, Al Asadi A, Entezari P, Chen R, Resnick S, Komanduri S, Gabr A, Thornburg B, Salem R, Riaz A. Post-embolization outcomes of splenic artery pseudoaneurysms: A single-center experience. Clin Imaging 2021; 80:160-166. [PMID: 34332465 DOI: 10.1016/j.clinimag.2021.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/22/2021] [Accepted: 07/19/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE Splenic artery pseudoaneurysms (PSA) are relatively rare but associated with high mortality/morbidity when presenting acutely. Embolization has emerged as the treatment of choice. We aim to evaluate the outcomes of embolization for the treatment of splenic artery PSAs. METHODS From 2007 to 2019, all patients that underwent embolization for splenic artery PSAs were included in this IRB-approved review. Evaluated outcomes included complications, morbidity/mortality rates, and 30-day white blood cell count. Student t-tests were performed to compare laboratory values before and after embolization. 5-year survival rates were estimated using Kaplan Meier methodology. RESULTS A retrospective analysis of 24 patients (14 males, mean age 51 ± 19 years) who underwent splenic artery PSA embolization was performed. Fifteen PSA embolizations were performed in an emergent setting. There was technical success in 23/24 patients. Etiologies included trauma (10), pancreatitis (9), post-surgical (3), and malignancy (2). Post-embolization patients had a mean length of stay of 19 days and within 30 days, 9 patients developed leukocytosis (median of 14,800/μl). The 5-year survival rate of these patients was 89% [95% CI 75% - 100%]. Post-procedure, 4 patients developed grade 2 complications. Grade 3 complications were observed in 5 patients. One (4.2%) splenic abscess was identified. Of the 19 patients with follow-up imaging, 14 patients had splenic infarcts (5 infarcts were >50% of splenic volume). CONCLUSIONS Splenic artery PSAs are encountered in the emergent setting and are most frequently secondary to trauma or pancreatitis. Embolization can be life-saving in these critically ill patients.
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Affiliation(s)
- Abhinav Talwar
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, IL, USA.
| | - Gabriel Knight
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, IL, USA.
| | - Ali Al Asadi
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, IL, USA
| | - Pouya Entezari
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, IL, USA
| | - Richard Chen
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, IL, USA.
| | - Scott Resnick
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, IL, USA.
| | - Sri Komanduri
- Department of Medicine, Division of Gastroenterology, Northwestern University, Chicago, IL, USA.
| | - Ahmed Gabr
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, IL, USA.
| | - Bartley Thornburg
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, IL, USA.
| | - Riad Salem
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, IL, USA; Department of Medicine, Division of Hematology and Oncology, Northwestern University, Chicago, IL, USA.
| | - Ahsun Riaz
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, IL, USA.
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29
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Atanasijevic I, Babic S, Tanaskovic S, Gajin P, Ilijevski N. Giant splenic artery aneurysm treated surgically with spleen and pancreas preservation. Ann Saudi Med 2021; 41:253-256. [PMID: 34420395 PMCID: PMC8380274 DOI: 10.5144/0256-4947.2021.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aneurysms of the splenic artery represent a rare clinical entity, even though they account for 60-70% of all visceral artery aneurysms. Splenic artery aneurysms larger than 5 cm are extremely rare, and they are considered to be giant. Possible causes of splenic artery aneurysm development include: trauma, hormonal and local hemodynamic changes in pregnancy, portal hypertension, arterial degeneration, infection and postsplenectomy occurrence. Surgical treatment of giant splenic artery aneurysms includes procedures that frequently require pancreatectomy and splenectomy. We present a case of a 10.2 cm giant splenic artery aneurysm, firmly adhered to the pancreas, which was treated surgically, with spleen and pancreas preservation. SIMILAR CASES PUBLISHED: Although many cases on treatment of giant splenic artery aneurysm have been published, the majority have described additional visceral resections associated with aneurysmectomy, which is in contrast with our report. Furthermore, aneurysms reaching 10 cm in size were extremely rare.
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Affiliation(s)
- Igor Atanasijevic
- From the Department of Vascular Surgery, Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
| | - Srdjan Babic
- From the Department of Vascular Surgery, Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
| | - Slobodan Tanaskovic
- From the Department of Vascular Surgery, Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
| | - Predrag Gajin
- From the Department of Vascular Surgery, Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
| | - Nenad Ilijevski
- From the Department of Vascular Surgery, Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
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30
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Moreno-Delgado J, Botía-Martínez C, Vallejo D, Díaz-Moreno E. Massive splenic infarction after blunt abdominal trauma in a pediatric patient. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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31
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Law NL, Villada FA, Kruse MJ. Rupture of splenic artery aneurysm in a man with polycythemia vera and acquired von Willebrand syndrome. BMJ Case Rep 2021; 14:14/6/e243316. [PMID: 34167989 DOI: 10.1136/bcr-2021-243316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Nathan L Law
- Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Fabio A Villada
- Radiology, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Matthew J Kruse
- Radiology, Creighton University School of Medicine, Omaha, Nebraska, USA
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32
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El Aidaoui K, Bensaad A, Habi J, El Yamani K, El Kettani C. Hemorrhagic Shock Revealing Rupture of Splenic Artery Pseudoaneurysm Three Years After Post-Traumatic Pancreatitis. Cureus 2021; 13:e15678. [PMID: 34277269 PMCID: PMC8283245 DOI: 10.7759/cureus.15678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 11/05/2022] Open
Abstract
Splenic artery pseudoaneurysm (SAP) is an uncommon entity but extremely serious, given the high mortality rate if untreated. Only a limited literature reports association with post-traumatic pancreatitis. We report the case of a 30-year-old man, who was brought to the emergency department (ED) for acute confusion. His past medical history includes trauma of right hypochondriac and epigastric regions, three years ago. Three days before his admission to the hospital, he experienced abdominal pain with nausea and vomiting, without transit disorders or fever. When examined, the patient was disoriented, pale with profuse sweating, cold extremities, and a temperature of 36.3°C. Blood pressure was 75/51 mmHg, heart rate was 126 beats per minute, and oxygen saturation was 96% on room air. The abdominal exam detected generalized abdominal sensitivity. A CT angiography of the abdomen revealed hemoperitoneum of medium abundance, with extravasation of the contrast product from the splenic artery. The size of the spleen was normal with a lower polar hypodense area. In addition, a pancreas of normal size, steady outlinings, seat of bilobed cystic formation suggested a pancreatic pseudocyst. This led us to suspect a rupture of a pseudoaneurysm of the splenic artery. A laparotomy was performed and showed an estimated 2 L hemoperitoneum. Active bleeding was noted from an SAP in the mid-portion of the splenic artery, next to the pancreatic pseudocyst. Ligation of the splenic artery and splenectomy was carried out. The patient was discharged home on the 10th post-operative day. Our case highlights an uncommon cause of hemorrhagic shock, but critical to recognize. Indeed, ruptured SAP needs to be promptly detected and managed, to avoid fatal complications if left untreated.
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Affiliation(s)
- Karim El Aidaoui
- Anesthesia and Critical Care, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, MAR
| | - Ahmed Bensaad
- Surgical Gastroenterology, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, MAR
| | - Jihane Habi
- Radiology, Cheikh Khalifa International University Hospital, Mohamed VI University of Health Sciences, Casablanca, MAR
| | - Khalid El Yamani
- Anesthesia and Critical Care, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, MAR
| | - Chafik El Kettani
- Anesthesia and Critical Care, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, MAR
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33
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Najjari K, Talebpour M, Amirbeigi A. Ruptured Splenic Artery Pseudoaneurysm 3 Years After Laparoscopic Sleeve Gastrectomy. Obes Surg 2021; 31:4185-4187. [PMID: 34033011 DOI: 10.1007/s11695-021-05479-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 05/09/2021] [Accepted: 05/13/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Khosrow Najjari
- Department of General Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Talebpour
- Department of General Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Amirbeigi
- Department of General Surgery, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
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34
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Khurram R, Al-Obudi Y, Glover TE, Shah R, Khalifa M, Davies N. Splenic artery pseudoaneurysm: Challenges of non-invasive and endovascular diagnosis and management. Radiol Case Rep 2021; 16:1395-1399. [PMID: 33912254 PMCID: PMC8063705 DOI: 10.1016/j.radcr.2021.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/09/2021] [Indexed: 01/03/2023] Open
Abstract
Splenic artery pseudoaneurysms (PAs) are uncommon and often occur as a complication of pancreatitis or trauma. Unlike true aneurysms, PAs are symptomatic in a majority of cases and patients can present with a constellation of non-specific symptoms. Diagnosis can be challenging due to variation in presenting features and mimicking pathologies. PAs are associated with a very high morbidity and mortality if left untreated. We present an unusual case of a 47-year-old gentleman diagnosed with a splenic artery pseudoaneurysm despite initial negative catheter angiography and discuss the challenges of splenic artery pseudoaneurysm diagnosis and management.
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35
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Sonanis S, Layton B, Nicholson O, Subar DA. Splenic artery pseudoaneurysm and resultant haematosuccus pancreaticus. BMJ Case Rep 2021; 14:14/3/e239485. [PMID: 33664031 PMCID: PMC7934783 DOI: 10.1136/bcr-2020-239485] [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: 11/04/2022] Open
Abstract
Splenic artery pseudoaneurysm (SAP) is a rare and dangerous diagnosis with a high risk of rupture and death. It is the most common cause of main pancreatic duct haematoma-haematosuccus pancreaticus (HP). Neither SAP nor HP have specific clinical features that allow diagnosis without cross-sectional imaging. Upper gastrointestinal haemorrhage and a history of pancreatitis should raise clinical suspicion but ultimately endoscopy and CT are required. We report a case of a 51-year-old man without clinical symptoms in whom cross-sectional imaging was undertaken for incidental severe acute anaemia. This demonstrated stigmata of chronic pancreatitis and the main pancreatic duct was distended with dense material in keeping with haematoma. The diagnosis of a SAP bleeding into the main pancreatic duct was made radiologically. A subsequent oesophago-gastro-duodenoscopy confirmed the diagnosis. The imaging appearances, pathophysiology and management are discussed.
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Affiliation(s)
| | - Benjamin Layton
- Radiology, East Lancashire Hospitals NHS Trust, Blackburn, Lancashire, UK
| | - Oliver Nicholson
- HPB surgery, Royal Blackburn Hospital, Blackburn, Lancashire, UK
| | - DA Subar
- HPB Surgery, Royal Blackburn Hospital, Blackburn, Lancashire, UK
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36
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Leow KS, Chieng JSL, Low HM, Lim KS, Kwek JW, Lim TC, Tan CH. Algorithm-based approach to hypervascular pancreatic lesions. Singapore Med J 2021; 62:113-119. [PMID: 33846754 DOI: 10.11622/smedj.2021027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Kheng Song Leow
- Department of Diagnostic Radiology, Woodlands Health Campus, Singapore
| | | | - Hsien Min Low
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | | | - Jin Wei Kwek
- Division of Oncology Imaging, National Cancer Centre Singapore, Singapore
| | - Tze Chwan Lim
- Department of Diagnostic Radiology, Woodlands Health Campus, Singapore
| | - Cher Heng Tan
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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37
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Fatal rupture of giant splenic artery pseudoaneurysm. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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38
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A review of anatomy, pathology, and disease spread in the perisplenic region. Abdom Radiol (NY) 2021; 46:805-817. [PMID: 32949273 DOI: 10.1007/s00261-020-02736-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/18/2020] [Accepted: 08/30/2020] [Indexed: 02/06/2023]
Abstract
The perisplenic region is a complex anatomical area involving multiple peritoneal and subperitoneal structures, which influence the presentation and behavior of various pathologic processes. This review is a comprehensive resource for perisplenic anatomy and pathology with associated clinical presentations and imaging findings. Understanding the pathophysiologic intricacies of the perisplenic region assists the radiologist in building a helpful differential diagnosis and recognizing predictable disease patterns.
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39
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Pseudoaneurysm of the Splenic Artery Following Bariatric Surgery. Obes Surg 2021; 31:2295-2297. [PMID: 33405183 DOI: 10.1007/s11695-020-05146-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/24/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
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40
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CONTI L, CATTANEO G, BANCHINI F, BODINI FC, PALMIERI G, CAPELLI P. Laparoscopic distal pancreasectomy and resection of retro-pancreatic splenic artery aneurysm: preserving the spleen. Chirurgia (Bucur) 2021. [DOI: 10.23736/s0394-9508.19.05052-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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41
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Tan MYQ, Wong AJTY, Aung L, Ng WM, Lee WF, Lim BL. Circulatory collapse from rupture of splenic artery aneurysm: A case study. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2021; 50:86-87. [PMID: 33623962 DOI: 10.47102/annals-acadmedsg.2020357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Mervin Ye Qing Tan
- Emergency Medicine Department, National University Health System, Singapore
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42
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Lee W, Qi-Huang S, Ahmed Z, Shah SS. Hemosuccus Pancreaticus in Chronic Pancreatitis: An Uncommon Cause of Gastrointestinal Bleeding. J Clin Imaging Sci 2020; 10:72. [PMID: 33274116 PMCID: PMC7708967 DOI: 10.25259/jcis_169_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/16/2020] [Indexed: 11/04/2022] Open
Abstract
We present a case of a 69-year-old female who arrived in hemorrhagic shock with symptoms of upper gastrointestinal bleeding. Imaging on admission was diagnostic of a large splenic artery pseudoaneurysm, which was presumed to have bled into the pancreatic duct given clinical symptoms of upper gastrointestinal bleeding. The pseudoaneurysm was successfully treated with coil embolization resulting in resolution of clinical symptoms.
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Affiliation(s)
- William Lee
- Department of Radiology, Nassau University Medical Center, East Meadow, New York, United States
| | - Sunny Qi-Huang
- Department of Radiology, Nassau University Medical Center, East Meadow, New York, United States
| | - Zaid Ahmed
- Department of Medicine, Idaho College of Osteopathic Medicine, Idaho, United States
| | - Salman S Shah
- Department of Radiology, Nassau University Medical Center, East Meadow, New York, United States
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43
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Tijani Y, Zahdi O, Hormat-Allah M, Zaid Y, Raux M, Gouëffic Y. [Embolization of splenic artery aneurysms: Treatment of choice. About a case and review of the literature]. Ann Cardiol Angeiol (Paris) 2020; 71:108-111. [PMID: 33267947 DOI: 10.1016/j.ancard.2020.11.002] [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: 08/17/2020] [Accepted: 11/04/2020] [Indexed: 10/22/2022]
Abstract
Splenic artery aneurysms constitute 60% of digestive artery aneurysms. They are often discovered incidentally and by imaging. Currently, endovascular treatment is considered the first-line treatment, as it is less invasive with less morbidity and mortality than surgery. An aggressive approach in their management is certainly justified because the overall mortality of ruptured splenic aneurysms is 25%. False splenic aneurysms have a greater potential for rupture than true aneurysms because they grow faster. Endovascular treatment is generally indicated for aneurysms larger than 2cm or with an increase in size of more than 0.5cm/year. Embolization is rarely associated with an infarction of the spleen due to the good supply of short gastric vessels. Embolization is performed using different materials including coils, which can be used alone or with other embolic agents. Post-embolization syndrome can be seen with persistent pain, fever and other systemic symptoms. Endovascular treatment compared to open surgery is associated with better quality of life and appears to be the most cost-effective strategy. Endovascular treatment and especially coil embolization are starting to be the standard treatment. Surgical and laparoscopic treatment are reserved for ruptured aneurysms which are burdened with significant mortality, especially in pregnant women. We report the case of a 66-year-old female patient in whom a splenic artery aneurysm was discovered incidentally during an ultrasound for an ovarian cyst.
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Affiliation(s)
- Y Tijani
- Département de chirurgie vasculaire et endovasculaire, Hôpital Universitaire International Cheikh Khalifa Ben Zaid, Faculté de Médecine, Université Mohammed VI des sciences de santé (UM6SS), Casablanca, Maroc.
| | - O Zahdi
- Service de chirurgie vasculaire, Centre hospitalo-universitaire Ibn Sina, Université Mohammed V, Rabat, Maroc
| | - M Hormat-Allah
- Service de chirurgie vasculaire, Centre hospitalo-universitaire Ibn Sina, Université Mohammed V, Rabat, Maroc
| | - Y Zaid
- Faculty of Sciences, Mohammed V University, Rabat, Maroc; Research Center of Abulcasis University of Health Sciences, Rabat, Maroc
| | - M Raux
- Department of vascular and endovascular surgery, hôpital Paris St Joseph, Paris, France
| | - Y Gouëffic
- Department of vascular and endovascular surgery, hôpital Paris St Joseph, Paris, France
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44
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Karaosmanoglu AD, Uysal A, Akata D, Ozmen MN, Karcaaltincaba M. Role of imaging in visceral vascular emergencies. Insights Imaging 2020; 11:112. [PMID: 33057847 PMCID: PMC7561664 DOI: 10.1186/s13244-020-00913-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/14/2020] [Indexed: 02/07/2023] Open
Abstract
Differential diagnosis in non-traumatic acute abdomen is broad and unrelated diseases may simulate each other from a clinical perspective. Despite the fact that they are not as common, acute abdominal pain due to diseases related to visceral vessels may be life-threating if not detected and treated promptly. Thrombosis, dissection, and aneurysm in the abdominal visceral arteries or thrombosis in visceral veins may cause acute abdominal pain. Imaging with appropriate protocoling plays a fundamental role in both early diagnosis and determination of the treatment approach in these cases where early treatment can be life-saving. Computed tomography (CT) appears to be the most effective modality for the diagnosis as it provides high detail images in a very short time. Patient cooperation is also a less concern as compared to magnetic resonance imaging (MRI). As the imaging findings may sometimes be really subtle, diagnosis may be difficult especially to inexperienced imagers. Correct protocoling is also very critical to detect arterial abnormalities as visceral arterial abnormalities may not be detectable in portal phase only abdominal CT scans. In this article, we aimed to increase awareness among imaging specialists to these not very common causes of acute abdomen.
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Affiliation(s)
| | - Aycan Uysal
- Department of Radiology, Gulhane Training and Research Hospital, 06010, Ankara, Turkey
| | - Deniz Akata
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | - Mustafa Nasuh Ozmen
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
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45
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Liyen Cartelle A, Uy PP, Yap JEL. Acute Gastric Hemorrhage due to Gastric Cancer Eroding Into a Splenic Artery Pseudoaneurysm: Two Dangerously Rare Etiologies of Upper Gastrointestinal Bleeding. Cureus 2020; 12:e10685. [PMID: 33133851 PMCID: PMC7593120 DOI: 10.7759/cureus.10685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Splenic artery pseudoaneurysms (SAPs) are rare causes of upper gastrointestinal bleeding (UGIB), with less than 250 reported cases in the literature. The highest incidence of SAPs is in patients with a history of acute or chronic pancreatitis or splenic artery trauma. SAP in the setting of gastric malignancy is an exceedingly rare finding. We present the unusual hospital course of an 82-year-old male with advanced gastric cancer presenting with UGIB secondary to a visceral communication between his known gastric malignancy and a SAP.
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Affiliation(s)
- Anabel Liyen Cartelle
- Gastroenterology and Hepatology, Medical College of Georgia at Augusta University, Augusta, USA
| | - Pearl Princess Uy
- Gastroenterology and Hepatology, Medical College of Georgia at Augusta University, Augusta, USA
| | - John Erikson L Yap
- Gastroenterology and Hepatology, Medical College of Georgia at Augusta University, Augusta, USA
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Leung E, Maingard J, Yeh J, Lee MJ, Brooks DM, Asadi H, Burrows DA, Kok HK. Contemporary endovascular management of splenic vascular pathologies. Clin Radiol 2020; 75:960.e23-960.e34. [PMID: 32819705 DOI: 10.1016/j.crad.2020.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 07/06/2020] [Indexed: 11/28/2022]
Abstract
The spleen is a commonly injured organ and the splenic vasculature is also susceptible to inflammation and trauma, often resulting in aneurysm formation. Splenic artery aneurysms carry a high risk of rupture and are associated with high mortality and morbidity. Due to the advances in endovascular techniques and devices, endovascular management of splenic vascular pathologies is now considered a first-line strategy. Endovascular embolisation and advance techniques including balloon- or stent-assisted coil embolisation enables minimally invasive management option while preserving splenic function.
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Affiliation(s)
- E Leung
- Interventional Radiology Service - Department of Radiology, Northern Health, Melbourne, Australia.
| | - J Maingard
- Interventional Neuroradiology Service - Monash Imaging, Monash Health, Melbourne, Australia; School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia
| | - J Yeh
- Interventional Radiology Service - Department of Radiology, Northern Health, Melbourne, Australia
| | - M J Lee
- Department of Radiology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - D M Brooks
- School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia; Interventional Neuroradiology Service - Radiology Department, Austin Hospital, Melbourne, Australia
| | - H Asadi
- Interventional Neuroradiology Service - Monash Imaging, Monash Health, Melbourne, Australia; School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia; Interventional Neuroradiology Service - Radiology Department, Austin Hospital, Melbourne, Australia
| | - D A Burrows
- Interventional Radiology Service - Department of Radiology, Northern Health, Melbourne, Australia
| | - H K Kok
- Interventional Radiology Service - Department of Radiology, Northern Health, Melbourne, Australia; School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia
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47
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Peters L, Zhao J, Makanyengo S, Pockney P. Delayed Splenic Artery Pseudoaneurysm After Laparoscopic Sleeve Gastrectomy. Obes Surg 2020; 31:872-874. [PMID: 32808170 DOI: 10.1007/s11695-020-04914-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/02/2020] [Accepted: 08/10/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Luke Peters
- Surgical Services, John Hunter Hospital, Lookout Road, New Lambton Heights, NSW, Australia. .,Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.
| | - Jie Zhao
- Surgical Services, John Hunter Hospital, Lookout Road, New Lambton Heights, NSW, Australia.,Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Samwel Makanyengo
- Surgical Services, John Hunter Hospital, Lookout Road, New Lambton Heights, NSW, Australia.,Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Peter Pockney
- Surgical Services, John Hunter Hospital, Lookout Road, New Lambton Heights, NSW, Australia.,Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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48
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Moramarco LP, Capodaglio CA, Quaretti P, Cionfoli N, Fiorina I, Disabella E, D'agostino AM, Urtis M, Arbustini E. Multivessel endovascular therapy for undiagnosed vascular type Ehlers-Danlos syndrome. Successful percutaneous transcatheter coil embolization of hepatic artery pseudoaneurysm with stenting of right renal and iliac arteries in emergency setting. BJR Case Rep 2020; 6:20200025. [PMID: 33299587 PMCID: PMC7709055 DOI: 10.1259/bjrcr.20200025] [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: 02/05/2020] [Revised: 04/17/2020] [Accepted: 06/21/2020] [Indexed: 11/05/2022] Open
Abstract
Among Ehlers-Danlos syndromes, the vascular type is the most severe because of its vascular complications. Transcatheter embolization of medium-sized arteries has become the first-line therapy for life-threatening hemorrhage. Ongoing multiple lesions causing hemorrhagic or ischemic complications in the acute phase can challenge patient management. Multivessel endovascular treatment has never been reported. In this study, we report successful single-session treatment by coiling of a ruptured pseudoaneurysm of the hepatic artery with stenting of dissected right renal and iliac arteries in a 46-year-old female. Percutaneous transfemoral approach was gained and sealed with a plug-based closure device. Genetic disease was subsequently confirmed by molecular analysis.
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Affiliation(s)
| | | | - Pietro Quaretti
- Unit of Interventional Radiology and Department of Radiology, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Nicola Cionfoli
- Unit of Interventional Radiology and Department of Radiology, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Ilaria Fiorina
- Unit of Interventional Radiology and Department of Radiology, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Eliana Disabella
- Centre for Inherited Cardiovascular Diseases of Cardio-Thoracic-Vascular Surgery Department, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | | | - Mario Urtis
- Centre for Inherited Cardiovascular Diseases of Cardio-Thoracic-Vascular Surgery Department, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Eloisa Arbustini
- Centre for Inherited Cardiovascular Diseases of Cardio-Thoracic-Vascular Surgery Department, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
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49
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Chaer RA, Abularrage CJ, Coleman DM, Eslami MH, Kashyap VS, Rockman C, Murad MH. The Society for Vascular Surgery clinical practice guidelines on the management of visceral aneurysms. J Vasc Surg 2020; 72:3S-39S. [DOI: 10.1016/j.jvs.2020.01.039] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 12/18/2022]
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50
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Maatman TK, Heimberger MA, Lewellen KA, Roch AM, Colgate CL, House MG, Nakeeb A, Ceppa EP, Schmidt CM, Zyromski NJ. Visceral artery pseudoaneurysm in necrotizing pancreatitis: incidence and outcomes. Can J Surg 2020; 63:E272-E277. [PMID: 32436687 DOI: 10.1503/cjs.009519] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background Visceral artery pseudoaneurysms (VA-PSA) occur in necrotizing pancreatitis; however, little is known about their natural history. This study sought to evaluate the incidence and outcomes of VA-PSA in a large cohort of patients with necrotizing pancreatitis. Methods Data for patients with necrotizing pancreatitis who were treated between 2005 and 2017 at Indiana University Health University Hospital and who developed a VA-PSA were reviewed to assess incidence, presentation, treatment and outcomes. Results Twenty-eight of 647 patients with necrotizing pancreatitis (4.3%) developed a VA-PSA between 2005 and 2017. The artery most commonly involved was the splenic artery (36%), followed by the gastroduodenal artery (24%). The most common presenting symptom was bloody drain output (32%), followed by incidental computed tomographic findings (21%). The median time from onset of necrotizing pancreatitis to diagnosis of a VA-PSA was 63.5 days (range 1-957 d). Twenty-five of the 28 patients who developed VA-PSA (89%) were successfully treated with percutaneous angioembolization. Three patients (11%) required surgery: 1 patient rebled following embolization and required operative management, and 2 underwent upfront operative management. The mortality rate attributable to hemorrhage from a VA-PSA in the setting of necrotizing pancreatitis was 14% (4 of 28 patients). Conclusion In this study, VA-PSA occurred in 4.3% of patients with necrotizing pancreatitis. Percutaneous angioembolization effectively treated most cases; however, mortality from VA-PSA was high (14%). A high degree of clinical suspicion remains critical for early diagnosis of this potentially fatal problem.
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Affiliation(s)
- Thomas K Maatman
- From the Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana (Maatman, Roch, House, Nakeed, Ceppa, Schmidt, Zyromski); the Indiana University School of Medicine, Indianapolis, Indiana (Heimberger, Lewellen); and the Center for Outcomes Research in Surgery (CORES), Indiana University School of Medicine, Indianapolis, Indiana (Colgate)
| | - Mark A Heimberger
- From the Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana (Maatman, Roch, House, Nakeed, Ceppa, Schmidt, Zyromski); the Indiana University School of Medicine, Indianapolis, Indiana (Heimberger, Lewellen); and the Center for Outcomes Research in Surgery (CORES), Indiana University School of Medicine, Indianapolis, Indiana (Colgate)
| | - Kyle A Lewellen
- From the Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana (Maatman, Roch, House, Nakeed, Ceppa, Schmidt, Zyromski); the Indiana University School of Medicine, Indianapolis, Indiana (Heimberger, Lewellen); and the Center for Outcomes Research in Surgery (CORES), Indiana University School of Medicine, Indianapolis, Indiana (Colgate)
| | - Alexandra M Roch
- From the Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana (Maatman, Roch, House, Nakeed, Ceppa, Schmidt, Zyromski); the Indiana University School of Medicine, Indianapolis, Indiana (Heimberger, Lewellen); and the Center for Outcomes Research in Surgery (CORES), Indiana University School of Medicine, Indianapolis, Indiana (Colgate)
| | - Cameron L Colgate
- From the Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana (Maatman, Roch, House, Nakeed, Ceppa, Schmidt, Zyromski); the Indiana University School of Medicine, Indianapolis, Indiana (Heimberger, Lewellen); and the Center for Outcomes Research in Surgery (CORES), Indiana University School of Medicine, Indianapolis, Indiana (Colgate)
| | - Michael G House
- From the Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana (Maatman, Roch, House, Nakeed, Ceppa, Schmidt, Zyromski); the Indiana University School of Medicine, Indianapolis, Indiana (Heimberger, Lewellen); and the Center for Outcomes Research in Surgery (CORES), Indiana University School of Medicine, Indianapolis, Indiana (Colgate)
| | - Attila Nakeeb
- From the Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana (Maatman, Roch, House, Nakeed, Ceppa, Schmidt, Zyromski); the Indiana University School of Medicine, Indianapolis, Indiana (Heimberger, Lewellen); and the Center for Outcomes Research in Surgery (CORES), Indiana University School of Medicine, Indianapolis, Indiana (Colgate)
| | - Eugene P Ceppa
- From the Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana (Maatman, Roch, House, Nakeed, Ceppa, Schmidt, Zyromski); the Indiana University School of Medicine, Indianapolis, Indiana (Heimberger, Lewellen); and the Center for Outcomes Research in Surgery (CORES), Indiana University School of Medicine, Indianapolis, Indiana (Colgate)
| | - C Max Schmidt
- From the Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana (Maatman, Roch, House, Nakeed, Ceppa, Schmidt, Zyromski); the Indiana University School of Medicine, Indianapolis, Indiana (Heimberger, Lewellen); and the Center for Outcomes Research in Surgery (CORES), Indiana University School of Medicine, Indianapolis, Indiana (Colgate)
| | - Nicholas J Zyromski
- From the Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana (Maatman, Roch, House, Nakeed, Ceppa, Schmidt, Zyromski); the Indiana University School of Medicine, Indianapolis, Indiana (Heimberger, Lewellen); and the Center for Outcomes Research in Surgery (CORES), Indiana University School of Medicine, Indianapolis, Indiana (Colgate)
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