Imaging Findings
A 65-year-old male patient who was previously fit and well presented with a sudden onset of anemia with his hemoglobin count dropping from 16 to 6.5 gm/dl in 8 days. All the biochemical and the
clotting parameters were found to be normal. An ultrasound exam performed on the patient showed a cystic mass with arterial flow in the pancreatic tail region. A CT scan was performed which
demonstrated a 6.7 cm pseudoaneurysm arising from the splenic artery (Fig. 1a and 1b). The pancreas were slightly enlarged with a lot of stranding in the surrounding mesentery. The spleen showed
multiple small infarcts. A splenic angiogram performed on the patient confirmed pseudoaneurysm (Fig 1c). Multiple endovascular coils ranging from 5 to 8 mm were placed proximally and distally to the
rent in the splenic artery with exclusion of the false aneurysm from circulation (Fig. 1d). A CT performed few days later confirmed the exclusion of the false aneurysm from circulation (Fig.1e). The
patient remained well on followup (Fig. 1f).
Discussion
Visceral artery pseudoaneurysms are not commonly found, with the splenic artery being the most commonly affected. Pancreatitis in both acute and chronic forms is the most common cause of most splenic
artery pseudoaneurysms. Post-traumatic pseudoaneurysm formation is the next commonest cause. Other rarer causes include peptic ulcer disease and iatrogenic disease with no cause identified in a few
cases. The presentation of splenic artery pseudoaneurysms varies from incidental finding to acute hemodynamic collapse in some patients. Rupture into pseudocysts is probably the cause for the
formation of larger pseudoaneurysms. Diagnosis is best established with either CT or ultrasound with Doppler and color flow studies. However, small pseudoaneurysms may be missed out when these
modalities are performed on the patient. Angiography is the most reliable diagnostic technique which allows the benefit of transcatheter embolization in appropriate patients. Selective embolization
with coil placement both proximally and distally to the rent in the splenic artery will exclude the false aneurysm from circulation. Selective transcatheter embolisation is a very safe procedure with
the added advantage of splenic preservation and should be considered as the therapeutic option of choice in the management of pseudoaneurysm caused by pancreatitis. Recently, a percutaneous thrombin
injection has been described as a treatment option.
Differential Diagnosis List
Splenic artery pseudoaneurysm secondary to pancreatitis.
Final Diagnosis
Splenic artery pseudoaneurysm secondary to pancreatitis.
