Splenic pseudoaneurysm

Fig. 8.4. a Nonselective celiac angiogram in a patient with a large splenic pseudoaneurysm after trauma. Note the marked vasospasm and contrast pooling in the left upper quadrant, b Coaxial use of a microcatheter to obtain access distal to the neck of the pseudoaneurysm despite the vasospasm, c Follow-up splenic angiogram after coil embolization of the splenic artery. No further contrast extravasation was noted and the patient s vitals stabilized. (Courtesy of James R. Duncan, MD)... 

Thrombosis of a splenic artery pseudoaneurysm has been reported in a patient receiving octreotide (24). 

A 55-year-old woman with a history of chronic pancreatitis developed epigastric pain and melena and was found to have a splenic artery pseudoaneurysm expanding a pseudocyst. She was given an intravenous bolus of octreotide followed by an infusion of 50 micrograms/ hour. A CT scan subsequently suggested thrombosis of the pseudoaneurysm, with segmental splenic infarction. Nine months later the pseudoaneurysm had recanalized. 

The octreotide may have contributed by causing vasoconstriction. A case of thrombosis in a splenic artery pseudoaneurysm in a patient receiving somatostatin has previously been reported (25). 

Tang LJ, Zipser S, Kang YS. Temporary spontaneous thrombosis of a splenic artery pseudoaneurysm in chronic pancreatitis during intravenous octreotide administration. J Vase Interv Radiol 2005 16(6) 863-6. 

De Rone T, VanBeers B, de Canniere L, Trigaux JP, Melange M. Thrombosis of splenic artery pseudoaneurysm complicating pancreatitis Gut 1993 34 1271-3. 

Fig.7.7a,b. Front and back door embolization of a splenic artery pseudoaneurysm (a) secondary to acute on chronic pancreatitis with a good result (b). This patient is alive and well with no recurrence at 52 months... 

Uflacker R, Diehl JC (1982) Successful embolisation of a bleeding splenic artery pseudoaneurysm secondary to necrotising pancreatitis. Gastrointest Radiol 7 379-382... 

Fig 4.1. a Selective splenic angiogram demonstrating a pseudoaneurysm arising from an upper pole branch after blunt trauma, b Selective splenic angiogram after coil embolization of the upper pole branch of the splenic artery supplying the injured splenic parenchyma... 

Davis KA, Fahian TC, Croce MA et al. (1998) Improved success in nonoperative management of hlunt splenic injuries emholization of splenic artery pseudoaneurysms. J Trauma 44 1008-1013... 

James CA, Emanuel PG, Vasquez WD et al. (1996) Embolization of splenic artery branch pseudoaneurysms after blunt abdominal trauma. J Trauma 40 835-837... 

Fig. 8.3. a Celiac angiogram in a patient with portal hypertension demonstrating a distal splenic artery aneurysm, b Celiac angiogram from another patient with multiple splenic aneurysms associated with portal hypertension who has undergone liver transplantation. Note the large hepatic pseudoaneurysm just medial to the upper pole of the right kidney, c Selective common hepatic artery injection in the patient from b... 

Brountzos EN et al. (2003) Pancreatitis-associated splenic artery pseudoaneurysm endovascular treatment with self-expandable stent-grafts. Cardiovasc Intervent Radiol 26 88-91... 

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