Incidental aneurysm

Fig 4.19 Incidental aneurysm found during evaluation for acute stroke. The collapsed MIP image shows a cut-off of the left MCA stem (arrow, a) and right MCA aneurysm (arrow, b). Corresponding shaded surface display... 

Unruptured aneurysms not associated with SAH should normally be clipped or coiled if they are symptomatic, for instance if there is a third nerve palsy caused by a posterior communicating artery aneurysm (Fig. 30.2) (Raps et al. 1993). The optimal management of incidental unruptured asymptomatic aneurysms is unclear because the risk of rupture is... 

Symptomatology depends on the extent and localization of the aneurysm, which can vary considerably in size, ranging from the diameter of a millet seed to that of a walnut (there have been cases where aneurysms as big as a grapefruit were observed). Small aneurysms do not cause any symptoms and are only discovered incidentally during imaging procedures or surgery. In most cases, patients complain of uncharacteristic abdominal pain, which may precede a rupture by several months. Large aneurysms are characterized by a continuous murmur. (132)... 

Enright T.R., Kanne J.P. (2010) Saccular superior vena cava aneurysm - incidental diagnosis by MDCT. Clin Radiol 65 421-422. 

Inagawa T (1991) Surgical treatment of multiple intracranial aneurysms. Acta Neurochir 108 22-29 Inagawa T, Hirano A (1990) Autopsy study of unruptured incidental intracranial aneurysms. Surg Neurol 34 361-365... 

Detection of incidental extracolonic findings has many possible advantages, such as early detection of malignant disease or of an unruptured abdominal aortic aneurysm. Early treatment can improve a patient s prognosis and decrease costs owing to less complicated surgical procedures and shorter hospital stays. 

It is clear that in case of true positive findings, such as the early diagnosis of abdominal aortic aneurysm or renal cell carcinoma, patients will benefit from incidental extracolonic findings. 

Jacobs I, Davies AP, Bridges J, Stabile I, Fay T, Lower A, Grudzin-skas JG, Oram D (1993) Prevalence screening for ovarian cancer in postmenopausal women by CA 125 measurement and ultrasonography. BMJ 306 1030-1034 Jamrozik K, Norman PE, Spencer CA, Parsons RW, Tuohy R, Lawrence-Brown MM, Dickinson JA (2000) Screening for abdominal aortic aneurysm lessons from a population-based study. Med J Aust 173(7) 345-350 Kloos RT, Korobkin M, Thompson NW, Francis IR, Shapiro B, Gross MD (1997) Incidentally discovered adrenal masses. Cancer Treat Res 89 263-292... 

Some aneurysms are asymptomatic and found incidentally on computed tomography (CT) performed for other reasons. Other patients may have a history of chronic abdominal pain but if haemorrhage occurs the pain may he more severe and circulatory collapse can occur. Contrast enhanced CT is usually performed and this may reveal a haematoma and sometimes the aneurysm itself, which is a useful guide for subsequent angiography. 

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