What Is a Splenic Artery Aneurysm?

A splenic aneurysm is an aneurysm formed by the expansion of the splenic artery. According to the tumor site, it can be divided into three types: the tumor is located in the main trunk of the splenic artery, and the distance from the spleen> 5cm is away from the spleen hilum; the tumor is located near the spleen hilum and is near the spleen hilum; the intermediate is the intermediate type. The vast majority are solitary, and the onset is hidden and difficult to diagnose.

Basic Information

English name

splenic artery aneurysm

Visiting department

Vascular surgery

Common causes

Atherosclerosis, splenic artery fibromuscular dysplasia, multiple pregnancy, portal hypertension, acute and chronic pancreatitis, etc.

Common symptoms

Pain, nausea, vomiting, ruptured splenic aneurysm, etc.

Causes of splenic aneurysms

Generally believed to be related to structural abnormalities of the arterial wall and changes in endocrine levels. The main causes include atherosclerosis, splenic artery fibromuscular dysplasia, multiple pregnancy, portal hypertension, and acute and chronic pancreatitis. Other rare causes include iatrogenic injury, trauma, and infection.

Clinical manifestations of splenic aneurysms

The splenic aneurysm is usually asymptomatic without rupture, with occasional left upper quadrant discomfort. Once the symptoms of pain, nausea, and vomiting in the left upper quadrant or left quarter costal region are obvious, they often indicate aura rupture. After the rupture, he had severe upper abdominal pain and left shoulder radiation pain (Kehr's sign), left subcostal tenderness, hypotension, and shock. Some splenic aneurysms are the first symptom of rupture and bleeding, and soon they appear shock or even die; if they break into the small omental sac, they can temporarily stop bleeding due to clot packing and compression, but they can rupture again into the abdominal cavity through the Winslow hole. In rare cases, the tumor can also form arteriovenous fistula with the portal vein system, causing portal hypertension.

Splenic aneurysm examination

Plain abdominal film

The vast majority of patients are found in non-targeted abdominal radiographs, and the typical sign is a curve of the left upper abdomen or a circular calcification.

2. Color Doppler ultrasound

Ultrasound examination revealed typical aneurysm manifestations with blood flow in the dark areas of the cyst. Color Doppler ultrasound can further determine the blood flow velocity and the presence of arterial embolism.

3.CTA and MRA

CTA can perform three-dimensional reconstruction of images, help identify the relationship between tumors and adjacent organs, and provide a basis for surgery. MRA images are similar to angiograms and spiral CT images.

4. Arteriography

Angiography is the "gold standard" for diagnosing visceral aneurysms. It can clarify the exact location, size, and adjacency of aneurysms, and it can help determine whether other aneurysms coexist. Can also be used for simultaneous interventional therapy.

Splenic aneurysm diagnosis

It is not easy to find splenic aneurysms in general clinical examination, and the early diagnosis of the disease is mainly determined by imaging examination.

Abdominal X-ray films suggest that the left upper quadrant has calcification, sudden left upper abdominal pain, left shoulder radiation pain, nausea, and vomiting. The possibility of splenic aneurysm should be considered; in a few cases, the mass can be touched, and there is pulsation and cat wheezing. Most cases have no obvious symptoms and are not diagnosed until the aneurysm has ruptured into the stomach, intestine or abdominal cavity. CTA, arteriography, and abdominal color Doppler ultrasound can help to make a clear diagnosis.

Differential diagnosis of splenic aneurysm

Symptoms such as abdominal pain, nausea, and vomiting need to be distinguished from pancreatitis and dyspepsia. Once acute abdomen with shock occurs, the disease and other visceral aneurysms should be considered. CTA and angiography can help differentiate diagnosis.

Splenic aneurysm treatment

Surgical treatment

The most ideal treatment for splenic aneurysms is surgical resection before the aneurysm is ruptured. The surgical indication is

(1) Those who have obvious symptoms, suspected aura rupture or have ruptured bleeding;

(2) Those with tumor diameter 2cm;

(3) Tumor diameter <2cm, but there is a continuous increase trend;

(4) Pregnant women or women of childbearing age should undergo elective surgery before or during pregnancy;

(5) For splenic aneurysms occasionally found during open surgery, if the disease permits, they should also be removed;

(6) Splenic aneurysms due to invasion, trauma, infection, etc. of adjacent organs should also be surgically removed as soon as possible.

2. Interventional Therapy

In recent years, with the advancement of interventional technology, splenic artery embolization, splenic artery intraluminal isolation and spring embolization assisted by bare stent have achieved good results in the treatment of splenic aneurysms. At present, endovascular interventional therapy has become the first treatment of the splenic artery.

Splenic aneurysm prevention

Once a splenic aneurysm ruptures, the mortality rate is extremely high, so early diagnosis is extremely important, and strive for timely surgery or interventional treatment before the aneurysm ruptures.