Spontaneous rupture of splenic artery pseudoaneurysm

Hordiychuk, Andriy; Mehanna, Daniel

doi:10.1093/jscr/rjac604

Cited by 7 publications

(3 citation statements)

References 8 publications

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“…Small splenic artery pseudoaneurysms can be asymptomatic (2.5% of cases [ 19 ]) and are usually identified as an incidental finding on imaging [ 3 , 7 , 8 ]. However, larger pseudoaneurysms (> 5 cm), termed “giant pseudoaneurysms”, are commonly symptomatic, although the risk of rupture seems not to be related to the pseudoaneurysm size [ 7 , 10 , 20 , 25 , 27 ]. SAPs may be detected on exam as a pulsatile mass in the upper left quadrant or epigastric region with associated left upper quadrant pain [ 3 , 4 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

“…It is important to treat all SAPs appropriately due to its risk of rupture resulting in hemorrhagic shock and death [3,4,8,9,13]. Ultrasound, contrast enhanced ultrasound (CEUS), computed tomography (CT) and magnetic resonance imaging (MRI) are imaging modalities that can play a role in diagnosing a SAP, however CT angiography (CTA) is the gold standard for diagnosis [3,4,[8][9][10]27]. As described above, our patient underwent a CT scan of the abdomen and pelvis with intravenous contrast which demonstrated active extravasation of contrast from the splenic artery into the splenic hilum, consistent with a ruptured SAP.…”

Section: Discussionmentioning

confidence: 99%

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Spontaneous rupture of a mycotic splenic artery pseudoaneurysm secondary to histoplasmosis: a case report

Mirande,

Souza,

Thibodeaux

et al. 2024

surg case rep

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Background A splenic artery pseudoaneurysm is a rare pathology that occurs mainly secondary to pancreatitis, abdominal trauma, peptic ulcers, pancreatic and gastric cancers, and infections. It is best diagnosed using computed tomography angiography and typically treated using endovascular embolization and, in some cases, open or laparoscopic surgery. In this report, we present a case of a ruptured mycotic splenic artery pseudoaneurysm containing Histoplasma capsulatum, which to our knowledge is the first case to report a mycotic splenic artery pseudoaneurysm of this nature. Case presentation We report a case of a 42-year-old white male with past medical history of Hepatitis C and IV drug abuse who presented to the Emergency Department with a 24-h history of severe diffuse abdominal pain. He was tachycardic and peritonitic on exam. Work-up demonstrated leukocytosis and lactic acidosis. Computed tomography of the abdomen and pelvis with intravenous contrast showed hemoperitoneum and active extravasation of contrast from the splenic artery into the splenic hilum, associated with a surrounding hematoma measuring 5.3 × 5.0 cm, concerning for ruptured splenic artery pseudoaneurysm. The patient was taken emergently for exploratory laparotomy, where a large intraperitoneal hematoma was evacuated. A ruptured splenic artery pseudoaneurysm was identified, isolated, and controlled, followed by completion splenectomy. Final pathology demonstrated a 3.0 × 1.3 × 0.3 cm pseudoaneurysm wall and a 14 × 9.5 × 5.5 cm spleen containing multiple necrotizing granulomata positive for the presence of Histoplasmosis species. The patient recovered appropriately and was discharged on post-operative day five. Conclusions This case demonstrates a successful approach to a ruptured mycotic splenic artery pseudoaneurysm resulting in a positive outcome. It is a unique case as it highlights, to our knowledge, the first report of splenic artery aneurysm secondary to Histoplasma capsulatum infection. This report helps further the understanding of the pathophysiology as well as the natural history of mycotic splenic pseudoaneurysms.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Spontaneous rupture of a mycotic splenic artery pseudoaneurysm secondary to histoplasmosis: a case report

Mirande,

Souza,

Thibodeaux

et al. 2024

surg case rep

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“…Visceral artery pseudoaneurysms (VAPs) are critical vascular abnormalities originating from the splanchnic circulation, often attributed to inflammatory, infectious, traumatic, iatrogenic, and neoplastic etiologies [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. Distinct from true aneurysms, pseudoaneurysms arise from the disruption of the intimal and medial layers of the arterial wall, lacking an epithelized wall structure [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Endovascular Treatment of Visceral Artery Pseudoaneurysms with Ethylene-Vinyl Alcohol (EVOH) Copolymer-Based Non-Adhesive Liquid Embolic Agents (NALEAs)

Minici,

Guerriero,

Fontana

et al. 2023

Medicina

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Background and Objectives: Treatment of visceral artery pseudoaneurysms (VAPs) is always indicated regardless of their diameters, as their risk of rupture is significantly higher than that of visceral artery aneurysms. The invasiveness of surgery and its associated complications have led to a shift in favor of radiological interventions as the initial treatment of choice. However, there are still some unanswered questions on endovascular treatment of VAPs regarding the optimal endovascular technique and the efficacy and safety outcomes. The purpose of this multicenter study was to retrospectively evaluate the effectiveness and safety of endovascular treatment of visceral pseudoaneurysms using Ethylene-Vinyl Alcohol (EVOH) Copolymer-Based Non-Adhesive Liquid Embolic Agents (NALEAs). Materials and Methods: Consecutive patients who underwent endovascular embolization with EVOH-based NALEAs for visceral artery pseudoaneurysms between January 2018 and June 2023 were retrospectively evaluated. Results: 38 embolizations were performed. Technical success was achieved in all patients. The clinical success rate was high (92.1% overall), with no significant differences between ruptured and unruptured VAPs (p = 0.679). Seven patients (18.4%) experienced procedure-related complications, related to one case of non-target embolization, four splenic abscesses due to end-organ infarction, and two femoral pseudoaneurysms. The rates of procedure-related complications, end-organ infarction, and vascular access-site complications did not significantly differ between ruptured and unruptured VAPs (p > 0.05). Conclusions: Both ruptured and unruptured visceral pseudoaneurysms can be effectively and safely treated with NALEA-based endovascular embolization. We suggest considering the use of NALEAs, particularly in specific clinical cases that highlight their advantages, including patients with coagulopathy, fragile vessels, and embolization targets that are located at a considerable distance from the microcatheter tip and are otherwise difficult to reach.

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A case report of spontaneous rupture of pancreaticoduodenal artery aneurysm

Liu

et al. 2023

Asian Journal of Surgery

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Spontaneous rupture of splenic artery pseudoaneurysm

Cited by 7 publications

References 8 publications

Spontaneous rupture of a mycotic splenic artery pseudoaneurysm secondary to histoplasmosis: a case report

Spontaneous rupture of a mycotic splenic artery pseudoaneurysm secondary to histoplasmosis: a case report

Endovascular Treatment of Visceral Artery Pseudoaneurysms with Ethylene-Vinyl Alcohol (EVOH) Copolymer-Based Non-Adhesive Liquid Embolic Agents (NALEAs)

A case report of spontaneous rupture of pancreaticoduodenal artery aneurysm

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