Spontaneous nontraumatic intrasplenic pseudoaneurysm: Causes, sonographic diagnosis, and prognosis

Görg, Christian; Cölle, J; Wied, M.; Schwerk, W. B.; Zugmaier, Gerhard

doi:10.1002/jcu.10145

Cited by 18 publications

(9 citation statements)

References 6 publications

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“…As expected, it could be confirmed that CEUS is highly superior to conventional sonography in terms of diagnostic accuracy and the grading of splenic injuries in both subgroups. The frequent occurrence of intrasplenic pseudoaneurysm is worth mentioning and confirmed previous results in the literature 14 . Additionally, CEUS findings had an influence on therapeutic management.…”

Section: Discussionsupporting

confidence: 90%

“…In contrast to TSR, spontaneous splenic rupture (SSR) is a rare disease and is usually diagnosed in non-surgical departments mostly by ultrasound. Only a few series of the ultrasound patterns of SSR have been reported 6 14 . In contrast to TSR, patients with SSR always show an underlying, mostly malignant disease with pathological infiltration or vascularization of an enlarged spleen.…”

Section: Discussionmentioning

confidence: 99%

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Spontaneous and Traumatic Splenic Rupture: Retrospective Clinical, B-Mode and CEUS Analysis in 62 Patients

Rosling

Trenker

Neeße

et al. 2018

Ultrasound Int Open

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Introduction Both B-mode ultrasound and contrast-enhanced ultrasound (CEUS) are well established procedures when diagnosing traumatic splenic ruptures (TSR). To date, there are no data about CEUS patterns in spontaneous splenic ruptures (SSR). It remains unknown whether TSR and SSR differ with respect to clinical characteristics, B-mode and CEUS characteristics. Patients and Methods Between 12/2003 and 2/2010, n=33 SSRs and n=29 TSRs were diagnosed in a tertiary referral center. All patients were examined with B-mode and CEUS, and clinical data and the outcome were retrospectively analyzed. Results Patients with SSR were significantly older than patients with TSR (62 years vs. 44 years; p=0.01). The 4-week mortality was significantly higher in SSR than in TSR (36% vs. 0%; p=0.001). No differences between the grading of TSR and SSR could be shown in B-mode or in CEUS. Notably, CEUS was significantly superior to B-mode with respect to the grading of splenic ruptures (p=0.01). Therefore, therapeutic management was influenced by CEUS. Conclusion There are differences between SSR and TSR, especially concerning clinical data (age, course of disease and mortality). Regarding the sonographic pattern, SSR and TSR show identical grading. When splenic rupture is suspected, CEUS should always be performed to identify patients at risk who require interventional procedures.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Spontaneous and Traumatic Splenic Rupture: Retrospective Clinical, B-Mode and CEUS Analysis in 62 Patients

Rosling

Trenker

Neeße

et al. 2018

Ultrasound Int Open

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“…Several reported cases described the association between anticoagulant therapy and subsequent splenic rupture (21)(22)(23)(24). While ultrasound appears to have a low diagnostic yield for SI, it is useful in the detection of complications following SI, such as splenic rupture with hemoperitoneum (25,26). A short-term follow-up with ultrasound is a reasonable strategy for patients in whom anticoagulants are initiated.…”

Section: Discussionmentioning

confidence: 99%

Anticoagulant Therapy Is Associated With Decreased Long-Term Mortality in Splenic Infarction Patients: A Multicenter Study

et al. 2021

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Background: Patients with splenic infarction (SI) are associated with a prothrombotic state and are vulnerable to subsequent thromboembolic complications. However, due to its rarity, there is no established treatment modality in this population. We aimed to examine the effect of anticoagulant therapy in SI patients.Methods: We performed a multicenter retrospective cohort study of 86 SI patients. Patients were categorized as anticoagulant users and anticoagulant non-users. The associations between anticoagulant therapy, all-cause mortality, thromboembolic events and bleeding events were evaluated.Results: Forty-five patients (52.3%) received anticoagulant therapy during the follow-up periods. The all-cause mortality rate was 6.86 per 100 patient-years. Anticoagulant therapy was associated with 94% improved survival (HR = 0.06; Cl 0.007–0.48; p = 0.008), while the risk factors for all-cause mortality were prior stroke (HR = 13.15; Cl 2.39–72.27; p = 0.003) and liver cirrhosis (HR = 8.71; Cl 1.29–59.01; p = 0.027). Patients with anticoagulant therapy had a higher event-free survival curve for thromboembolic complications (p = 0.03) but did not achieve a significant difference after adjustment using the Cox regression model as a time-dependent covariate (HR = 0.57; Cl 0.13–2.45; p = 0.446). There was no significant difference in the risk of bleeding events between the groups (p = 0.728).Conclusions: Anticoagulant therapy in patients with SI was associated with better survival and was not related to an increased bleeding risk.

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“…A rare complication of splenic trauma is pseudoaneurysm. It has been reported in up to14% of patients with splenic trauma [51]. This may be regarded as a special form of occult splenic rupture [52].…”

Section: Patients With Blunt Abdominal Traumamentioning

confidence: 99%

Contrast Enhanced Sonography for Diagnosis of (Peri-) Splenic Pathology

Görg¹,

Bert

2007

CMIR

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Objective: Ultrasound contrast agents in conjunction with contrast specific imaging techniques, are increasingly accepted in clinical use for diagnostic imaging in several organs. Contrast enhanced sonography (CES) of second generation contrast media have shown a spleen-specific uptake of the microbubble contrast agent. The aim of this review is to illustrate indications for the use of CES in patients with suspected (peri-)splenic pathology.Methods: This pictorial review based on the experience of transcutaneous CES in 180 consecutive adult patients with (peri-)splenic pathology diagnosed by B-mode sonography at an internal medicine center. CES studies were performed with a contrast-devoted unit (Acuson, Sequoia, Siemens medical solution) that had contrast-specific, continuous-mode software. A low mechanical index was used. A sulfur hexafluoride-based microbubble contrast medium (Sonovue ® , Bracco SpA, Milan, Italy) was injected.Results: On our experience there are six clinical conditions which indicates the use of CES for diagnosis of (peri-)splenic pathology: 1. the perisplenic tumor, 2. the small sized spleen, 3. the inhomogenous spleen of unknown cause, 4. the incidentally found hypoechoic splenic tumor, and 5. pain in the left upper quadrant, and 6. patients with blunt abdominal trauma. CES is of value 1. to diagnose or exclude accessory spleen, 2. to diagnose functional asplenia/hyposplenia, 3. to diagnose focal lesions in an inhomogenous spleen, 4. to diagnose high vascular splenic hemangioma, 5. to diagnose or exclude splenic infarction and splenic abscess, and 6. to diagnose splenic laceration.Conclusion: CES is of diagnostic value in several clinical circumstances to diagnose accessory spleen, functional asplenia, small sized splenic involvement, high vascular splenic hemangioma, and vascular splenic pathology like splenic infarction, splenic abscess, and splenic laceration.

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Spontaneous nontraumatic intrasplenic pseudoaneurysm: Causes, sonographic diagnosis, and prognosis

Cited by 18 publications

References 6 publications

Spontaneous and Traumatic Splenic Rupture: Retrospective Clinical, B-Mode and CEUS Analysis in 62 Patients

Spontaneous and Traumatic Splenic Rupture: Retrospective Clinical, B-Mode and CEUS Analysis in 62 Patients

Anticoagulant Therapy Is Associated With Decreased Long-Term Mortality in Splenic Infarction Patients: A Multicenter Study

Contrast Enhanced Sonography for Diagnosis of (Peri-) Splenic Pathology

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