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Giant splenic artery aneurysm is a rare condition that represents an eminent life threatening for the patient, requiring, therefore, urgent surgical correction. A 61-year-old woman, former smoker, hypertensive, hypercholesterolemic and multipara sought our service because of a large tumor in the mesogastrium, which was an abdominal ultrasound finding. Despite the size of the tumor, the patient was asymptomatic. The angiotomography and the magnetic resonance image of the abdomen were suggestive of giant splenic artery aneurysm with more than 10cm in diameter that was confirmed by an angiography. She underwent surgery, open splenectomy, and partial aneurysmectomy. The approach of the celiac artery, which was ligated, was only possible with medialvisceral rotation because there was no possibility to view it through the anterior access. The histopathological test of aneurysmatic wall revealed atheroma plaques in the intima. The patient progressed without complications and she was discharged cured. In general, giant splenic artery aneurysms are symptomatic, however, as in the case we report, it may be asymptomatic and found in abdominal imaging exam. Although less invasive Interventional methods exist, such as laparoscopy and endovascular techniques, they were considered inappropriate in this case. Conventional open surgery should be the therapy of choice for a giant splenic artery aneurysm.

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Introduction: Thoracic aortic aneurysm diameter determination is paramount for the decision-making process regarding surgical management. Studies focusing in asymptomatic patients have determined prevalence of 0.16 to 0.36% of TAAs in imaging studies. Several groups have proposed automated aortic measurement tools as propaedeutic and therapeutic instruments. In this study we developed and tested an automatic 3-dimensional (3D) segmentation method for the thoracic aorta, applicable on computed tomography angiography (CTA) acquired using low-dose and standard dose protocol, with and without contrast enhancement; and to accurately calculate the 3D diameter information of the arterial segments. Methods: a retrospective cohort of all CT scans acquired in our service between 2016 and 2021 led to the selection of 587 CT exams including low and standard-dose radiation, with and without contrast enhancement. 527 exams were used for neural network training of an algorithm capable of aptly measuring the aortic diameters, using manual measurements performed by three medical specialists as a baseline. Sixty exams were used for validation. The algorithm was developed both for use with the support of PyRadiomics and for a self-made approach. Results: Aortic measurement using the algorithm supported by PyRadiomics resulted in mean absolute error values under 2mm. For the self-made approach, mean absolute error values were under 5mm. Conclusion: This study presents an effective automated solution for thoracic aortic measurement with good results in sets of standard or low-radiation exams, as well as those acquired with or without contrast enhancement; presenting a possibility for an auxiliary tool for automation of the process of measuring the diameter of the thoracic aorta.

BACKGROUND Percutaneous transluminal angioplasty and stenting represent an effective treatment for hepatic artery stenosis after liver transplantation. In the first year after stenting, approximately 22% of patients experience in-stent restenosis, increasing the risk of artery thrombosis and related complications, and 50% experience liver failure. Although angiography is an important tool for diagnosis and the planning of therapeutic interventions, it may raise doubts, especially in small-diameter arteries, and it provides low resolution rates compared with newer intravascular imaging methods, such as optical coherence tomography (OCT). CASE SUMMARY A 64-year-old male developed hepatic artery stenosis one year after orthotropic liver transplantation and was successfully treated with percutaneous transluminal angioplasty with stenting. Five months later, the Doppler ultrasound results indicated restenosis. Visceral arteriography confirmed hepatic artery tortuosity but was doubtful for significant in-stent restenosis (ISR) and intrahepatic flow reduction. To confirm ISR, identify the etiology and guide treatment, OCT was performed. OCT showed severe stenosis due to four mechanisms: Focal and partial stent fracture, late stent malapposition, in-stent neointimal hyperplasia, and neoatherosclerosis. CONCLUSION Intravascular diagnostic methods can be useful in evaluating cases in which initial angiography results are not sufficient to provide a proper diagnosis of significant stenosis, especially with regard to ISR. A wide range of diagnoses are provided by OCT, resulting in different treatment options. Interventional radiologists should consider intravascular diagnostic methods as additional tools for evaluating patients when visceral angiography results are unclear.