SONOWORLD : Traumatic splenic artery pseudoaneurysm

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Abdomen » Spleen

Traumatic splenic artery pseudoaneurysm

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Author(s) :

Chaitali Shah, FRCR

Presentation Young male presenting with history of blunt abdominal trauma. Vital signs are normal.

Caption: Sagittal section of the spleen.

Description: Sagittal section of the spleen showing a hypoechoic lesion close to the splenic hilum. This lesion shows no posterior enhancement and no distinct walls are noted in association with the lesion.

Caption: Transverse sonogram of the spleen.

Description: Transverse sonogram of the spleen shows a hypoechoic lesion, with some perisplenic fluid.

Caption: Power Doppler study of the lesion.

Description: Power Doppler study shows that the lesion is vascular in nature.

Caption: Spectral Doppler of the vascular lesion.

Description: Spectral Doppler study of the vascular lesion in the spleen reveals an arterial waveform.

Differential Diagnosis Traumatic pseudoaneurysm

Final Diagnosis Traumatic pseudoaneurysm

Discussion An aneurysm is the abnormal enlargement or bulging of an artery caused by damage to or weakness in the blood vessel wall. Pseudoaneurysm formation of the intraparenchymal splenic artery is a rare complication of traumatic splenic injury. Pathologically, a false aneurysm lacks any components of a vessel wall. These false aneurysms, or pseudoaneurysms, are really cavities, typically within hematomas, that communicate with a vessel lumen. Gray scal ultrasound combined with color Doppler imaging is very effective in diagnosing a pseudoaneurysm. Gray scale imaging would show an echo poor area within the spleen, which demonstrates pulsatile flow using color and spectral Doppler. Contrast enhanced CT will visualize the lesion during the arterial phase of the opacification. Magnetic resonance angiography (MRA) or catheter angiography will definitively confirm the diagnosis. The major complication of an unrecognized splenic arterial pseudoaneurysm is delayed rupture of the spleen. Therefore, once a splenic artery pseudoaneurysm is diagnosed, it is either surgically ligated or embolized transarterially. Hiraide et al in 1994 reported a case of intrasplenic pseudoaneurysm following blunt trauma. It progressively enlarged on serial radiographic studies until it eventually ruptured. Therefore, in order to avoid spontaneous rupture, all pseudoaneurysms of the splenic artery, regardless of their etiology, are treated aggressively either with surgical ligation or percutaneous transarterial embolization. The pseudoaneurysm may form months or even years after the initial injury, hence a follow up is recommended for the non-operative management of blunt abdominal trauma.

Case References 1.Sugg SL, Gerndt SJ, Hamilton BJ, Francis IR, Taheri PA, Rodriguez JL. Pseudoaneurysms of the intraparenchymal splenic artery after blunt abdominal trauma: a complication of nonoperative therapy and its management. J Trauma. 1995 Sep; 39(3): 593-5.
2. Hiraide A, Yamamoto H, Yahata K, Yoshioka T, Sugimoto T. Delayed rupture of the spleen caused by an intrasplenic pseudoaneurysm following blunt trauma: case report. J Trauma. 1994 May; 36(5): 743-4.
3. Norotsky MC, Rogers FB, Shackford SR. Delayed presentation of splenic artery pseudoaneurysms following blunt abdominal trauma: case reports. J Trauma 1995; 38: 444-447.
4.Tessier DJ, Stone WM, Fowl RJ, Abbas MA et al. Clinical features and management of splenic artery pseudoaneurysm: case series and cumulative review of literature. J Vasc Surg. 2003 Nov; 38(5): 969-74.

Follow Up The patient underwent an angiogram, which showed a small intrasplenic pseudoaneurysm near the splenic hilum. Successful embolization of the splenic artery branch supplying the same was performed.