Splenic vein aneurysm: Is it a surgical indication?

Torres, Gustavo; Hines, George L.; Monteleone, Frank; Hon, Man; Diel, Jack

doi:10.1016/s0741-5214(99)70320-4

Cited by 29 publications

(26 citation statements)

References 10 publications

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“…17 The aetiology of SVA in non-pregnant women includes portal hypertension and liver cirrhosis, 18 chronic pancreatic inflammation 8 and vessel wall weakness. 19 Splenic vein rupture during pregnancy is associated with acute pancreatic necrosis eroding the splenic vein, 10 acute vessel wall inflammation, 20 and splenic artery aneurysm rupture into the splenic vein. 21,22 In other cases the aetiology remains unknown and splenic vein rupture is labelled 'spontaneous' to account for the lack of apparent trauma or disease.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Spontaneous splenic vein aneurysm rupture in the puerperium

Parpaglioni

Metta

Zagari

et al. 2009

International Journal of Obstetric Anesthesia

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Section: Discussionmentioning

confidence: 99%

“…The standard management of SVA rupture remains emergency surgery which allows SVA resection, distal pancreatectomy, splenectomy and spleno-renal shunt. 19 Finally, rapid-sequence induction of general anaesthesia was not performed. In our hospital this technique is not commonly used.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous splenic vein aneurysm rupture in the puerperium

Parpaglioni

Metta

Zagari

et al. 2009

International Journal of Obstetric Anesthesia

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“…Portal system aneurysms can be divided into two types: extrahepatic and intrahepatic (2,3). SVA is a true aneurysm and belongs to the extrahepatic portal venous system category (1,(3)(4)(5).…”

Section: Discussionmentioning

confidence: 99%

“…SVA is a true aneurysm and belongs to the extrahepatic portal venous system category (1,(3)(4)(5). Lowenthal and Jacob (4) described the first case of SVA in 1953.…”

Section: Discussionmentioning

confidence: 99%

Splenic Vein Aneurysm Demonstrated by Magnetic Resonance Angiography

et al. 2005

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KEY WORDS: splenic vein; aneurysm; magnetic resonance angiography.Splenic vein aneurysm (SVA) is an extremely rare vascular abnormality (1, 2). We report a SVA in a rheumatoid arthritis (RA) patient which was demonstrated by Doppler sonography, contrast-enhanced computed tomography (CT), and magnetic resonance angiography (MRA). The present case is the tenth SVA patient reported in the English literature. Furthermore, this is the first case of a SVA which was demonstrated by MRA. The literature regarding this entity is discussed and the characteristic MR angiographic appearance of a nonthrombosed splenic vein aneurysm is presented. CASE REPORTA 77-year-old man who had a 37-year history of RA was admitted to the physical therapy and rehabilitation department of our hospital with pain and swelling in his left wrist and right metacarphophalangeal joints 6 months ago. He was also suffering from a feeling of abdominal fullness. He had no history of jaundice, hematemesis, melena, pancreatitis, alcohol abuse, or trauma. He had been treated with sulfasalazine, 2 g per day, for 3 years.Physical examination revealed swelling of the left wrist and right metacarphophalangeal joints. The patient had RA deformities including swan-neck, unlar deviation, and boutonniere deformity. There was limitation of motion in several joints including the fingers, right wrist, right elbow and knees. His liver and spleen were not palpable and there were no abdominal masses. During palpation, the patient described a mild, dull pain in his left upper abdomen. On admission, his blood pressure was 150/85 mm Hg, and his pulse rate was 90/min and regular.Normal hemoglobin level, white blood cell count, and platelet count were revealed by means of laboratory studies. Liver enzymes were normal. Sedimentation rate was high (52 mm/hr).Serum markers of viral hepatitis were all negative. Abdominal sonography demonstrated a round anechoic mass, 40 × 20 mm in diameter, at the level of the splenic hilum. Color Doppler ultrasound (CDU; Hitachi EBU 525; Tokyo) displayed a venous aneurysm at the splenic hilium. It had spectral findings characteristic of the extrahepatic portal venous system (Figure 1). There were no ultrasonic features of portal hypertension. Subsequent contrast-enhanced CT of the abdomen (Philips, CT Secura, NT) (section thickness = 10 mm) revealed a markedly enhanced focal cystic dilatation of the splenic vein ( Figure 2). Contrastenhanced phase-contrast MRA (Philips, 1.5 T, Gyroscan Intera, NT) with a breath-hold, three-dimensional technique confirmed the aneurysmal lesion in the splenic vein ( Figure 3). There were no abnormal findings in the portal and superior mesenteric veins, such as thrombus, stricture, or portal hypertension. Upper gastrointestinal endoscopy was unremarkable. Our patient was followed up for 6 months with color Doppler ultrasonography and MRA. There were no change in the size or number of the SVA.

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“…Therefore, we believe that the typical EUS findings of an SVA are focal dilatation of the splenic vein in B-mode images with continuous flow in the pulsed-wave Doppler mode. The best treatment strategy for incidentally detected asymptomatic SVAs remains controversial [2,3]. We elected to monitor this lesion rather than perform surgery, and there was no change on either abdominal ultrasound or EUS at the 48-month follow-up.…”

mentioning

confidence: 99%

Endoscopic ultrasound diagnosis of a small splenic vein aneurysm

et al. 2014

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Splenic vein aneurysm (SVA) is an extremely rare vascular abnormality. Although endoscopic ultrasound (EUS) can detect vascular structures, the characteristic findings of an SVA have not been reported. We describe a patient with an SVA found incidentally on an EUS that was performed for gastric antral ectopic pancreas. The diagnosis was based on the findings during EUS using an electronic radial scanning echoendoscope (EG-530UR; Fujifilm Corp., Saitama, Japan) with color Doppler flow-mapping capabilities. We identified a focally dilated distal splenic vein at the level of the pancreatic tail (• " Fig. 1 a, b), and a venous flow signal was detected by pulsed-wave Doppler ultrasound (• " Fig. 1c). Based on these findings, we diagnosed an SVA. Subsequent venous-phase three-dimensional computed tomography angiography (CTA) revealed a venous aneurysm on the splenic vein, confirming the final diagnosis of SVA (• " Fig. 2). A splenic artery aneurysm (SAA) is similar to an SVA in form and shape, and must be distinguished from an SVA. We previously reported the characteristic EUS findings of SAAs [1]. EUS using pulsed-wave Doppler mode shows a pulsating arterial wave in an SAA. In contrast, it shows continuous flow in an SVA. Therefore, we believe that the typical EUS findings of an SVA are focal dilatation of the splenic vein in B-mode images with continuous flow in the pulsed-wave Doppler mode. The best treatment strategy for incidentally detected asymptomatic SVAs remains controversial [2, 3]. We elected to monitor this lesion rather than perform surgery, and there was no change on either abdominal ultrasound or EUS at the 48-month follow-up. To our knowledge, this is the first reported case of an SVA diagnosed by EUS.

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Splenic vein aneurysm: Is it a surgical indication?

Cited by 29 publications

References 10 publications

Spontaneous splenic vein aneurysm rupture in the puerperium

Spontaneous splenic vein aneurysm rupture in the puerperium

Splenic Vein Aneurysm Demonstrated by Magnetic Resonance Angiography

Endoscopic ultrasound diagnosis of a small splenic vein aneurysm

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