Unlike splenic artery true aneurysms, splenic artery pseudoaneurysms will nearly always present with symptoms 2. Fewer than 200 cases of splenic artery pseudoaneurysms are reported in the English literature 2.
While they are sometimes grouped under splenic arterial aneurysms, they are distinct entity and are different from true aneurysms of the splenic artery. In contrast to a true aneurysm the pseudoaneurysm wall contains only the intimal and medial layers 2.
Their size can vary and if larger than 5 cm they are called giant splenic artery pseudoaneurysms 3.
They usually occur as a complication of 1-2:
In the case of pancreatitis, pancreatic enzymes are thought to cause a necrotising arteritis with destruction of vessel wall architecture and fragmentation of elastic tissues.
In the traumatic setting, they are actually more often intraparenchymal and rarely involve the main splenic artery.
CT is the modality of choice in assessing splenic trauma:
- true aneurysms will appear just as they do at other locations
- intraparenchymal pseudoaneurysms have a similar appearance to active haemorrhage on initial scanning but do not increase in size on delayed phases and follow the blood pool on all phases
- intraparenchymal pseudoaneurysms and AV fistulas have a similar appearance and cannot be differentiated on CT
- in contrast, active haemorrhage appears as a high density (80-95 Hounsfield units) material due to the extravasation of IV contrast media that increases in size on delayed imaging
- 1. Tessier DJ, Stone WM, Fowl RJ et-al. Clinical features and management of splenic artery pseudoaneurysm: case series and cumulative review of literature. J. Vasc. Surg. 2003;38 (5): 969-74. doi:10.1016/S0741 - Pubmed citation
- 2. Agrawal GA, Johnson PT, Fishman EK. Splenic artery aneurysms and pseudoaneurysms: clinical distinctions and CT appearances. AJR Am J Roentgenol. 2007;188 (4): 992-9. doi:10.2214/AJR.06.0794 - Pubmed citation
- 3. Goldberg RF, Maley W, Kennedy EP et-al. Giant splenic artery pseudoaneurysm. J. Gastrointest. Surg. 2011;15 (6): 1063-6. doi:10.1007/s11605-010-1388-3 - Pubmed citation
- 4. Saba L, Anzidei M, Lucatelli P et-al. The multidetector computed tomography angiography (MDCTA) in the diagnosis of splenic artery aneurysm and pseudoaneurysm. Acta Radiol. 2011;52 (5): 488-98. doi:10.1258/ar.2011.100283 - Pubmed citation