Abstract:A rare case of berry splenic artery aneurysm (SAA) rupture associated with segmental arterial mediolysis (SAM) and portal hypertension is reported. A 66-year-old woman, diagnosed as having liver cirrhosis and portal hypertension 6 years earlier, suddenly developed a lancinating pain in the upper abdomen and lost consciousness. She recovered consciousness while being transferred to hospital by ambulance. During the investigations, her level of consciousness suddenly deteriorated. Ultrasonography showed a massiv… Show more
“…Other causes of ruptured splenic artery aneurysms include congenital causes such as anomalous origin [8], Berry aneurysm [9] and arteriovenous malformation [10] and acquired conditions such as pancreatitis [11] and possible toxic causes resulting in vessel wall damage [12]. …”
Splenic artery aneurysms are rare. We discuss a case of a 58-year-old gentleman presenting with collapse and shock secondary to spontaneous splenic artery aneurysm rupture. Patient underwent laparotomy and splenectomy then discharged home within a week of presentation.
“…Other causes of ruptured splenic artery aneurysms include congenital causes such as anomalous origin [8], Berry aneurysm [9] and arteriovenous malformation [10] and acquired conditions such as pancreatitis [11] and possible toxic causes resulting in vessel wall damage [12]. …”
Splenic artery aneurysms are rare. We discuss a case of a 58-year-old gentleman presenting with collapse and shock secondary to spontaneous splenic artery aneurysm rupture. Patient underwent laparotomy and splenectomy then discharged home within a week of presentation.
“…The disease most commonly involves visceral arteries such as the superior or inferior mesenteric, splenic, hepatic and renal arteries in the elderly 3,9 . The patients usually complain of sudden abdominal pain, abdominal distention, vital abnormalities and unconsciousness 9–11 . It has also been reported that several intracranial aneurysms were due to SAM 12–14 .…”
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confidence: 99%
“…It has also been reported that several intracranial aneurysms were due to SAM 12–14 . The etiology of SAM is poorly understood, but it is thought that vasospasm is relevant 1,3,4,7,10 . Complication with autoimmune diseases such as microscopic polyangiitis (MPA) has also been reported 15,16 .…”
mentioning
confidence: 99%
“…3,9 The patients usually complain of sudden abdominal pain, abdominal distention, vital abnormalities and unconsciousness. [9][10][11] It has also been reported that several intracranial aneurysms were due to SAM. [12][13][14] The etiology of SAM is poorly understood, but it is thought that vasospasm is relevant.…”
This is the first report of segmental arterial mediolysis (SAM) accompanied with polyarteritis nodosa (PN), and manifesting aneurysms of the renal arteries. A 73-year-old woman was admitted to hospital because of a high fever. Laboratory tests showed leukocytosis with increased CRP level in the serum. Myeloperoxidase-anti-neutrophil cytoplasmic antibody (MPO-ANCA) and proteinase 3 (PR3)-ANCA were negative. There were no signs indicating infection or malignancy. After admission renal function rapidly deteriorated. Treatment was then started with daily oral prednisolone and hemodialysis. On the 40th day of hospitalization the patient suddenly became comatose. Cranial CT showed a subarachnoid hemorrhage. The patient died and an autopsy was performed. The pathological findings showed necrotizing vasculitis of the small arteries in various organs, but not associated with that of arterioles or renal glomerular lesions, indicating PN. Unexpectedly, the segmental arteries of the bilateral kidneys showed vascular lesions of dissecting aneurysms, indicating SAM. This case indicates that SAM is one of the causes of aneurysms in PN and is clinically important when the clinical course of PN patients rapidly advances.
“…Most of the aneurysms are caused by degenerative atherosclerosis, portal hypertension secondary to liver cirrhosis, pancreatitis, pregnancy, congenital causes such as anomalous origin, Berry aneurysm, arteriovenous malformation [2,9,7,11,5,10].…”
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