Presentation
Patient workup for anemia. Asymptomatic.
Patient Data
Focal dilatation of the splenic artery near the splenic hilum, with high resistance arterial Doppler flow in its interior.
The spleen is homogenous, normal in size without focal lesions.
Case Discussion
The splenic artery is the third most common site of intraabdominal aneurysms, after aneurysms of the abdominal aorta and the iliac arteries 1.
The real prevalence of splenic artery aneurysms is unknown, but with the wider use of cross-sectional imaging, there is an increasing frequency of incidental diagnosis. Females are affected four times as often as males, potentially related to increased incidental or symptomatic discovery coinciding with the use of US in pregnancy 2.
In one of the largest study series developed at Mayo Clinic during 1980-1998 with 217 patients, it was revealed that 79% of affected patients were female, with a mean age of 61 years. 95% of splenic aneurysms were solitary and the majority of patients were asymptomatic 3.
The reason for development is unknown, associations have been made with multiparity, portal hypertension, liver transplantation, systemic hypertension, medial fibroplasia, and α1-antitrypsin deficiency. Hormonal and portal flow changes in pregnancy are believed to be related to the development of splenic artery aneurysms 2.
Contrast-enhanced CT is usually the study of choice, encountering a low-attenuation mass continuous with the splenic artery that demonstrates internal arterial phase enhancement if patent. Ultrasound is also an option for real time examination and evaluation of the Doppler dynamics within the aneurysm.
The risk of rupture increases when the aneurysm measures more than 2 cm. The endovascular treatment of choice is coil or liquid casting agent embolization (typically reserved for saccular aneurysms and those with adequate or alternate flow to the spleen).
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