Pseudoaneurysm of the splenic artery mimicking a solid lesion

A 64-year-old man presented to the hospital because of hematemesis; on admission, he had weakness and pale skin, tachycardia and hypotension. Laboratory tests revealed severe anemia (hemoglobin 7.8 g/dL); liver, renal and pancreatic function tests were normal. An upper digestive endoscopy revealed a gastric ulcer of the cardia, treated with metallic clips and adrenalin injection. The patient was treated with fluids and was transfused with three units of red blood cells. In the previous two months, due to the presence of bloating and diarrhea, associated with abdominal distension, a colon-computed tomography (CT) revealed a large retroperitoneal hypodense mass, 53x37 mm in size, without contrast enhancement localized between the body and the tail of the pancreas and the stomach, near the splenic artery and without signs of infiltration. To better define the mass, endoscopic ultrasound and biopsy were performed; however histopathology of multiple biopsies was not diagnostic, because of the presence of necrotic tissue and inflammatory cells. Since hematemesis recurred, the patient underwent a second upper digestive endoscopic examination, but no source of bleeding was found. Then a new contrast enhanced CT was performed that showed a size reduction of the mass, the presence of blood in the stomach and a small pseudoaneurysm of the splenic artery. Because of these findings an angiograpghic study was carried out; angiography confirmed a splenic artery pseudoaneurysm that was successfully embolized with metal microcoils.

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Morphometric analysis of the splenic artery using contrast-enhanced computed tomography (CT)

Surgical and Radiologic Anatomy ◽

10.1007/s00276-020-02598-1 ◽

2020 ◽

Author(s):

David J. Brinkman ◽

Stephanie Troquay ◽

Wouter J. de Jonge ◽

Eric D. Irwin ◽

Margriet J. Vervoordeldonk ◽

...

Keyword(s):

Immune Modulation ◽

Splenic Artery ◽

Experimental Studies ◽

Pancreatic Tissue ◽

Branching Pattern ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

And Gender ◽

Enhanced Computed Tomography

Abstract Purpose To evaluate the morphology and course of the splenic artery, which might impact the surgical implantation of systems that stimulate the nerves surrounding the splenic artery. Experimental studies indicate that these nerves play an important part in immune modulation, and might be a potential target in the treatment of autoimmune diseases. Methods This retrospective cohort study made use of contrast-enhanced CT images from 40 male and 40 female patients (age 30–69) that underwent a CT examination of the aorta, kidneys or pancreas. Anatomic features were described including total splenic artery length, calibers, tortuosity, the presence of arterial loops and the branching pattern of the splenic artery. Results No age-gender-related differences could be found related to tortuosity or branching pattern. The length of splenic artery in contact with pancreatic tissue decreased with increasing age, but was not different between genders. Artery diameters were wider in male compared to female subjects. Loops of variable directions, that represent a part of the artery that curls out of the pancreatic tissue, were identified in each age-gender category and were present in nearly all subjects (86%). Conclusion This study suggests that although some anatomic features of the splenic artery are subject to factors as age and gender, the tortuosity of the splenic artery is not age dependent. Most subjects had one or multiple loops, which can serve as a target for neuromodulatory devices. Future studies should investigate whether splenic nerve stimulation is safe and feasible.

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Giant Splenic Artery Pseudoaneurysm: A Case Report and Literature Review

International Surgery ◽

10.9738/intsurg-d-15-00043.1 ◽

2015 ◽

Vol 100 (7-8) ◽

pp. 1244-1248 ◽

Cited By ~ 6

Author(s):

Yusuf Yagmur ◽

Sami Akbulut ◽

Serdar Gumus ◽

Firat Demircan

Keyword(s):

Splenic Artery ◽

En Bloc Resection ◽

Bloc Resection ◽

Clinical Findings ◽

Abdominal Aneurysm ◽

En Bloc ◽

Abdominal Ultrasonography ◽

Artery Pseudoaneurysm ◽

Contrast Enhanced Ct ◽

Asymptomatic Patients

Splenic artery aneurysms (SAAs) are the third most frequent intra-abdominal aneurysm, following abdominal aorta and iliac artery aneurysms. SAAs are classified according to their involvement of arterial wall layers: true aneurysms involve all 3 layers (intima, media, and adventitia), and pseudoaneurysms involve only one or two. Herein we present a new case of giant pseudo SAA. A 65-year-old female patient with a pancreatic mass and iron deficiency was referred to our clinic for further investigation. Abdominal ultrasonography, contrast-enhanced CT and magnetic resonance imaging showed a lesion resembling a subcapsular hemangioma in the spleen, and aneurysmatic dilation of the splenic artery with a diameter of >5 cm. The large size of the aneurysm and the clinical findings were indications for surgical treatment. The patient underwent en bloc resection of the spleen, distal pancreas, and aneurysmatic segment of the splenic artery. The patient remains complication-free 2 months after the operation. Spontaneous rupture is the most important life-threatening complications of giant SAAs. Therefore, all symptomatic patients with SAA should be treated, as well as asymptomatic patients with lesions ≥2 cm, who are pregnant or fertile, have portal hypertension, or are candidates for liver transplantation. Despite advances in endovascular techniques, conventional abdominal surgery remains the gold standard for treatment.

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Early presentation of traumatic pseudoaneurysm of deep lingual artery as a massive oral bleed

BMJ Case Reports ◽

10.1136/bcr-2020-240928 ◽

2021 ◽

Vol 14 (4) ◽

pp. e240928

Author(s):

Ramya Rathod ◽

Neha Choudhary ◽

Bharat Hosur ◽

Sandeep Bansal

Keyword(s):

Successful Outcome ◽

Lingual Artery ◽

Early Presentation ◽

Artery Pseudoaneurysm ◽

Pseudoaneurysm Formation ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Traumatic Pseudoaneurysm ◽

Secondary Haemorrhage ◽

High Index Of Suspicion

Tongue trauma with active bleed is most commonly due to the ruptured lingual artery and its branches, whereas delayed haemorrhage is usually secondary to pseudoaneurysm formation. This case is a unique presentation of traumatic tongue bleeds with early formation of pseudoaneurysm of a lingual artery branch. We present our experience in its management. A contrast-enhanced CT (CECT) with angiography detected right deep lingual artery pseudoaneurysm, which was managed by endovascular gelfoam embolisation followed by tongue laceration repair. Tongue bleed stopped immediately post embolisation; tongue viability and functions restored on postoperative day 1 of repair. No complications like secondary haemorrhage or tongue necrosis were noted at 1-month follow-up. High index of suspicion for lingual artery and/or its branch pseudoaneurysm is crucial in acute and uncontrollable traumatic tongue bleed. A CECT is a minimum norm in early diagnosis. Choice of management is the cornerstone of a successful outcome.

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Budd-Chiari Syndrome Caused by TIPS Malposition: A Case Report

Case Reports in Medicine ◽

10.1155/2014/267913 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

A. S. Katkar ◽

Anderson H. Kuo ◽

S. Calle ◽

K. Gangadhar ◽

K. Chintapalli

Keyword(s):

Abdominal Distension ◽

Caudate Lobe ◽

Hepatic Veins ◽

Budd Chiari Syndrome ◽

Venous Outflow ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Chiari Syndrome ◽

Intrahepatic Portosystemic Shunt ◽

Venous Outflow Obstruction

Budd-Chiari syndrome refers to hepatic pathology secondary to diminished venous outflow, most commonly associated with venothrombotic disease. Clinically, patients with Budd-Chiari present with hepatomegaly, ascites, abdominal distension, and pain. On imaging, Budd-Chiari syndrome is hallmarked by occluded IVC and or hepatic veins, caudate lobe enlargement, heterogeneous liver enhancement, intrahepatic collaterals, and hypervascular nodules. Etiopathological factors for Budd-Chiari syndrome include several systemic thrombotic and nonthrombotic conditions that can cause venous outflow obstruction at hepatic veins and/or IVC. While the transjugular intrahepatic portosystemic shunt (TIPS) is used as a treatment option for Budd-Chiari syndrome, Budd-Chiari syndrome is not a well-known complication of TIPS procedure. We report a case of Budd-Chiari syndrome that occurred in a transplanted cirrhotic liver from malpositioned proximal portion of the TIPS in IVC causing occlusion of the ostia of hepatic veins which was subsequently diagnosed on contrast-enhanced CT.

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Mid-term outcome of transarterial embolization of renal artery pseudoaneurysm and arteriovenous fistula after partial nephrectomy screened by early postoperative contrast-enhanced CT

CVIR Endovascular ◽

10.1186/s42155-020-00160-z ◽

2020 ◽

Vol 3 (1) ◽

Author(s):

Satoru Morita ◽

Yuka Matsuzaki ◽

Takahiro Yamamoto ◽

Kumi Kamoshida ◽

Hiroshi Yamazaki ◽

...

Keyword(s):

Renal Artery ◽

Partial Nephrectomy ◽

Transarterial Embolization ◽

Term Outcome ◽

Artery Pseudoaneurysm ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

Renal Artery Pseudoaneurysm

Abstract Purpose To retrospectively evaluate the mid-term outcome of transarterial embolization (TAE) of renal artery pseudoaneurysm (RAP) including arteriovenous fistula (AVF) after partial nephrectomy screened by early postoperative contrast-enhanced CT (CE-CT). Materials and methods Eighty-two patients (7.0%) who underwent TAE after partial nephrectomy were reviewed, from 1166 partial nephrectomies performed over 6 years. In 18 patients (22.0%), TAE was performed emergently on the median postoperative day (POD) seven. In the remaining patients, elective TAE was performed on the median POD six for RAP detected by early postoperative CE-CT or that emerged on follow-up CE-CT. Results In one patient (1.2%), TAE was performed twice because one of two RAPs could not be embolized during the first TAE, being successfully embolized at the second TAE after readmission with hematuria. Otherwise, no bleeding recurrence or RAPs were observed during the median 1354 follow-up days. Thus, the primary and secondary success rates of TAE were 98.8% (81 of 82 patients) and 100% (82 of 82 patients), respectively. On angiography, the average number of lesions was 1.7 ± 0.9 and the average RAP size was 12.8 ± 6.0 mm. The shapes of the lesions varied: oval-round 60, oval-round + AVF 36, irregular + AVF 14, AVF 12, irregular 10, disruption 4, and extravasation 3. No major complications were observed. The median inpatient days after TAE were two. No estimated glomerular filtration rate deterioration was observed (64.6 ± 18.6 vs. 64.2 ± 18.4 mL/min/1.73 m2, p = 0.902). Conclusion TAE is largely effective and safe for treating bleedings or RAPs, including AVFs, after partial nephrectomy, as screened by early postoperative CE-CT.

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Massive hepatomegaly in a neonate: an unusual cause

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20164618 ◽

2016 ◽

Vol 4 (1) ◽

pp. 274

Author(s):

Ritika Khurana ◽

Anju Aggarwal ◽

Aashima Dabas ◽

Natasha Gupta

Keyword(s):

Liver Biopsy ◽

Ct Scan ◽

Abdominal Distension ◽

Costal Margin ◽

Radiological Evaluation ◽

Kidney Size ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

Multiple Nodules

A female neonate presented with progressive abdominal distension. Liver was palpable, 11 cm below costal margin and a spleen of 10 cm. USG abdomen revealed massive hepatomegaly with multiple nodules in liver, kidney size and texture being normal. Contrast enhanced CT scan of the abdomen was suggestive of enlarged multinodular liver with splenomegaly. Liver biopsy revealed replacement of liver architecture by small rounded cells, which were positive for synaptophysin and S100 stains suggestive of neuroblastoma. A repeat abdominal radiological evaluation revealed a small 2 x 1 cm mass in left suprarenal area. Neuroblastoma stage 4S presenting as hepatomegaly is rare.

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Contrast-enhanced Computed Tomography Imaging of Splenic Artery Aneurysms and Pseudoaneurysms: A Single-center Experience

Journal of Clinical Imaging Science ◽

10.4103/jcis.jcis_21_18 ◽

2018 ◽

Vol 8 ◽

pp. 37 ◽

Cited By ~ 1

Author(s):

Jacob Therakathu ◽

Hirenkumar Kamleshkumar Panwala ◽

Salil Bhargava ◽

Anu Eapen ◽

Shyamkumar Nidugala Keshava ◽

...

Keyword(s):

Computed Tomography ◽

Liver Disease ◽

Chronic Liver Disease ◽

Splenic Artery ◽

Artery Aneurysm ◽

Chronic Liver ◽

Imaging Features ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Picture Archiving And Communication

Aim: The aim of our study was to evaluate the computed tomography (CT) imaging features of splenic artery aneurysm and pseudoaneurysm and to identify the disease conditions related to the same. We also wanted to ascertain any relationship between these associated disease conditions and the imaging features of the aneurysms. Materials and Methods: This retrospective study included patients diagnosed to have splenic artery aneurysms on contrast-enhanced CT examination between January 2001 and January 2016. Data were obtained from the picture archiving and communication system. The size, number, location, morphology, the presence of thrombosis, calcification, and rupture of the aneurysms were evaluated. Results: A total of 45 patients were identified with a mean age of 45 years. Splenic artery aneurysms were idiopathic in 12 (26.6%) patients. In the remaining patients, the main associated disease conditions included pancreatitis 15 (33%), chronic liver disease with portal hypertension 8 (18%), and extrahepatic portal vein obstruction (EHPVO) 6 (13%). Statistically significant findings included the relationship between EHPVO and multiple aneurysms (P = 0.002), chronic liver disease and fusiform aneurysm (P = 0.008), and smaller size of idiopathic aneurysms (P < 0.001). Conclusion: Based on this study, splenic artery aneurysms were associated with a variety of etiologies. The characteristics of the aneurysms such as size, location, and morphology vary with the associated disease conditions. These variations may have implications for the management.

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Rasmussen’s aneurysm masquerading as mass lesion

BMJ Case Reports ◽

10.1136/bcr-2019-232669 ◽

2020 ◽

Vol 13 (2) ◽

pp. e232669

Author(s):

Satyajeet Sahoo ◽

Manoj Kumar Panigrahi ◽

Suprava Naik ◽

Prasanta Raghab Mohapatra

Keyword(s):

Mass Lesion ◽

Male Smoker ◽

Adequate Treatment ◽

Artery Pseudoaneurysm ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

Pulmonary Disorder ◽

Life Threatening ◽

Pulmonary Artery Pseudoaneurysm

Haemoptysis is an often encountered respiratory symptom. The amount of haemoptysis varies from mild to life-threatening severity and may indicate the underlying pulmonary disorder. Herein, we report a 50-year-old male smoker who presented with occasional streaky to mild haemoptysis for last 1 year. He had pulmonary tuberculosis 10 years ago and had received adequate treatment. Chest radiograph was suspicious of a mass lesion in left upper lung. Contrast-enhanced CT scan of thorax revealed pulmonary artery pseudoaneurysm suggestive of Rasmussen’s aneurysm. Unlike this case, Rasmussen’s aneurysm usually manifests as life-threatening haemoptysis and portends a high mortality.

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Imaging findings in Fetus-in-fetu-misdiagnosed commonly as teratoma

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20214169 ◽

2021 ◽

Vol 8 (11) ◽

pp. 1905

Author(s):

Rajakumar R. ◽

Annu Singhal ◽

Sana Sana ◽

Kavita Vani

Keyword(s):

Rare Condition ◽

Abdominal Distension ◽

Malignant Potential ◽

The Body ◽

Retroperitoneal Mass ◽

Girl Child ◽

Fetus In Fetu ◽

Contrast Enhanced ◽

Enhanced Computed Tomography ◽

Contrast Enhanced Computed Tomography

Fetus in fetu is a rare condition associated with abnormal embryogenesis in a diamniotic, monochorionic pregnancy, wherein one of the fetus is enclosed within the body of another normally developing fetus. It should be differentiated from a teratoma because of the later’s malignant potential. Here we report a case of 2 months old girl child who presented with complaints of abdominal distension. USG showed a solid cystic retroperitoneal mass resembling an anencephalic fetus. Contrast enhanced Computed tomography (CT) showed similar findings with visualization of bones resembling femur, sacrum and vertebrae. Findings were correlated with MRI and post-op pathology. The preoperative diagnosis of FIF is based on the observation of vertebral column or limbs in a mass on imaging modalities and our case meets the required criteria.

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