Splanchnic Vessel AneurysmsSplanchnic Vessel Aneurysms ::

Ultrasound Findings Ultrasound Findings in Combining with MSCT 64in Combining with MSCT 64

in Vietnam in Vietnam..

Nguyen Thien Hung Nguyen Thien Hung - Le van Tai - Le Thanh Liem- Le van Tai - Le Thanh Liem- Nguyen Vinh Thinh – Tran Minh Dung - Phan Thanh Hai- Nguyen Vinh Thinh – Tran Minh Dung - Phan Thanh Hai

Medic Medical Center, Ho Chi Minh City, Medic Medical Center, Ho Chi Minh City, Vietnam.Vietnam.

Splanchnic Artery AneurysmsSplanchnic Artery AneurysmsShabana F. PashaShabana F. Pasha, , Peter GloviczkiPeter Gloviczki, , Anthony W. StansonAnthony W. Stanson, ,

Patrick S. KamathPatrick S. Kamath

AbstractAbstract

Autopsy : splanchnic artery aneurysms more Autopsy : splanchnic artery aneurysms more frequent than abdominal aortic aneurysms. frequent than abdominal aortic aneurysms.

Important to recognize = up to 25% may be Important to recognize = up to 25% may be ruptured, (mortality rate after rupture = 25% and ruptured, (mortality rate after rupture = 25% and 70%). 70%).

However, little is known about the natural history However, little is known about the natural history and clinical presentation of splanchnic artery and clinical presentation of splanchnic artery aneurysms. aneurysms.

Splanchnic Artery AneurysmsSplanchnic Artery AneurysmsShabana F. PashaShabana F. Pasha, , Peter GloviczkiPeter Gloviczki, , Anthony W. StansonAnthony W. Stanson, ,

Patrick S. KamathPatrick S. Kamath

Splenic artery aneurysms are the most common; Splenic artery aneurysms are the most common; multiple aneurysms = 1/3 of patients. multiple aneurysms = 1/3 of patients.

Hepatic artery pseudoaneurysms are more Hepatic artery pseudoaneurysms are more common than true aneurysms common than true aneurysms

because of increasing numbers of hepatobiliary because of increasing numbers of hepatobiliary interventional procedures.interventional procedures.

Splanchnic Artery AneurysmsSplanchnic Artery AneurysmsShabana F. PashaShabana F. Pasha, Peter Gloviczki, Anthony W. Stanson, , Peter Gloviczki, Anthony W. Stanson,

Patrick S. KamathPatrick S. Kamath

The diagnosis of splanchnic artery aneurysm should be The diagnosis of splanchnic artery aneurysm should be considered in considered in

any patient with abdominal pain, any patient with abdominal pain, a pulsatile mass,a pulsatile mass, or an abdominal bruit or an abdominal bruit with or without associated bleeding.with or without associated bleeding.

However, most aneurysms are asymptomaticHowever, most aneurysms are asymptomatic and are detected incidentally and are detected incidentally on imaging studies. on imaging studies.

Splanchnic Artery AneurysmsSplanchnic Artery AneurysmsShabana F. PashaShabana F. Pasha, Peter Gloviczki, Anthony W. Stanson, , Peter Gloviczki, Anthony W. Stanson,

Patrick S. KamathPatrick S. Kamath

Treatment, which can be either surgical or interventional radiology-Treatment, which can be either surgical or interventional radiology-based, should be considered inbased, should be considered in

all patients with symptoms related to the aneurysms,all patients with symptoms related to the aneurysms,

if the aneurysm is more than 2 cm in diameter, if the aneurysm is more than 2 cm in diameter,

if the patient is pregnant,if the patient is pregnant,

or if there is demonstrated growth of the aneurysm. or if there is demonstrated growth of the aneurysm.

----------------------------------------------------------------Source: Mayo Clin Proc. 2007;82:472-479.Source: Mayo Clin Proc. 2007;82:472-479.

Distribution of splanchnic artery aneurysms (AA).

Pasha S F et al. Mayo Clin Proc. 2007;82:472-479

© 2007 Mayo Foundation for Medical Education and Research

Purpose:Purpose:

Splanchnic vessel aneurysms are rare conditions and Splanchnic vessel aneurysms are rare conditions and possible having severe complications: rupture, possible having severe complications: rupture, thrombus, organ ischemia, but could be disclosed in thrombus, organ ischemia, but could be disclosed in their asymptomatic status by some modalities of their asymptomatic status by some modalities of diagnostic imaging : Doppler ultrasound and multislice diagnostic imaging : Doppler ultrasound and multislice CT (MSCT). CT (MSCT). Our report aims to evaluate the abilities of ultrasound Our report aims to evaluate the abilities of ultrasound in detecting some splanchnic vessel aneurysms in in detecting some splanchnic vessel aneurysms in routine examination and confirming that by MSCT.routine examination and confirming that by MSCT.

ObjectivesObjectives:: Having by chance some asymptomatic aneurysms ofHaving by chance some asymptomatic aneurysms of hepatic artery (post cholecystectomy),hepatic artery (post cholecystectomy), gastroepiploic artery,gastroepiploic artery, celiac artery, celiac artery, gastroduodenal artery, gastroduodenal artery, portal vein (extrahepatic and intrahepatic),portal vein (extrahepatic and intrahepatic), superior mesenteric artery,superior mesenteric artery, splenic artery and splenic vein, splenic artery and splenic vein, intrarenal artery,intrarenal artery, by ultrasound and confirmed them by MSCT later.by ultrasound and confirmed them by MSCT later. Most of cases were in watched and follow-up studies Most of cases were in watched and follow-up studies and no one in rupture after discovering.and no one in rupture after discovering.

Hepatic Artery AneurysmHepatic Artery Aneurysm

Post endoscopic cholecystectomy for one month, a 44yo female patient got hematemesis and epigastric pain. US revealed an 1cm mass with yingyan sign. MSCT confirmed an hepatic artery aneurysm.

Hepatic Artery AneurysmHepatic Artery Aneurysm

Gastroepiploic Artery AneurysmGastroepiploic Artery Aneurysm

Having turbulent flow, a #26x27x30mm gastroepiploic artery aneurysm which was connected a branch of hepatic artery, was nearby superior mesenteric artery.

Gastroepiploic Artery AneurysmGastroepiploic Artery Aneurysm

Coeliac trunk aneurysm with turbulent flow.

CELIAC ARTERY ANEURYSM

CELIAC ARTERY ANEURYSM

CELIAC ARTERY ANEURYSM

EXTRAHEPATIC PORTAL VEIN ANEURYSMEXTRAHEPATIC PORTAL VEIN ANEURYSM

Superior Mesenteric Artery AneurysmSuperior Mesenteric Artery Aneurysm

Aneurysm of SMA # 53mm with turbulent flow.

Superior Mesenteric Artery AneurysmSuperior Mesenteric Artery Aneurysm

Left Portal Vein Aneurysm Left Portal Vein Aneurysm

Left branch of portal vein : a venous aneurysm # 26x29x27mm, thin wall with turbulent spectral flow .

Left Portal Vein AneurysmLeft Portal Vein Aneurysm

Splenic Vein AneurysmSplenic Vein Aneurysm

Cystic lesion #45x39mm, yinyang sign (+), venous spectral pattern nearby the spleen hilus.

Splenic Vein AneurysmSplenic Vein Aneurysm

Intrarenal Artery AneurysmIntrarenal Artery Aneurysm

Intrarenal cystic lesion # 25mm with arterial spectral pattern.

Intrarenal Artery AneurysmIntrarenal Artery Aneurysm

Discussions:Discussions:

Ultrasound B-mode in some cases could not Ultrasound B-mode in some cases could not characterize completely the nature of splanchnic characterize completely the nature of splanchnic aneurysm but could show the aneurysm but could show the vascular wallvascular wall and and dimensionsdimensions. .

It was more sensitive to detect splanchnic vessel It was more sensitive to detect splanchnic vessel aneurysms with color Doppler imaging technique in aneurysms with color Doppler imaging technique in

presenting the presenting the direction of blood flowdirection of blood flow and and turbulencesturbulences..

Discussions (cont.):Discussions (cont.): Meanwhile with MSCT Angiography the Meanwhile with MSCT Angiography the

characterization of splanchnic vessel aneurysms characterization of splanchnic vessel aneurysms was more perfect and more reliable in their 3D was more perfect and more reliable in their 3D reconstruction images. reconstruction images.

But color ultrasound could be the first choice to But color ultrasound could be the first choice to disclose and follow-up splanchnic vessel disclose and follow-up splanchnic vessel aneurysms in our Vietnam country. aneurysms in our Vietnam country.

..

Conclusions:Conclusions:

Color ultrasound could be the screening Color ultrasound could be the screening method to detect early asymptomatic method to detect early asymptomatic splanchnic vessel aneurysms by combining an splanchnic vessel aneurysms by combining an advanced technique as MSCT, and follow-up advanced technique as MSCT, and follow-up in Vietnam. in Vietnam.