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Splenic Artery Aneurysms and Pseudoaneurysms: Clinical Distinctions and CT Appearances

¹ All authors: Department of Radiology, Johns Hopkins School of Medicine, 601 N Caroline St., Rm. 3251, Baltimore, MD 21287.

View larger version (38K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —Schematic of normal splenic artery, splenic artery aneurysm, and pseudoaneurysm. In true aneurysm, wall is composed of intima (I), media (M), and adventitia (A); in comparison, pseudoaneurysm wall contains only intima and media. In setting of pancreatitis, splenic artery pseudoaneurysm may result from weakening of wall by pancreatic enzymes [5]. (Illustration by Frank Corl)

View larger version (170K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2 —44-year-old woman undergoing evaluation as potential renal donor with no significant medical history. Arterial phase contrast-enhanced CT scan shows 2-cm distal splenic artery aneurysm located near splenic hilum, which was confirmed with arteriography.

View larger version (151K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3 —78-year-old man with history of treated bladder cancer who presented with persistent hematuria. Arterial phase contrast-enhanced CT scan reveals 2-cm aneurysm arising from mid portion of splenic artery.

View larger version (161K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —63-year-old woman with splenic artery aneurysm detected 2 years previously who is being evaluated for stability. Axial arterial phase contrast enhanced CT scan (A) and sagittal oblique multiplanar reformation (B) show 1.8-cm aneurysm with dense peripheral calcification. Aneurysm appeared unchanged since prior examination.

View larger version (142K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —63-year-old woman with splenic artery aneurysm detected 2 years previously who is being evaluated for stability. Axial arterial phase contrast enhanced CT scan (A) and sagittal oblique multiplanar reformation (B) show 1.8-cm aneurysm with dense peripheral calcification. Aneurysm appeared unchanged since prior examination.

View larger version (122K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5 —50-year-old woman with history of Gaucher's disease and incidentally discovered splenic artery aneurysm on CT. Axial arterial phase contrast-enhanced CT scan shows 2.2-cm, partially thrombosed, peripherally calcified aneurysm (arrow) arising from distal splenic artery.

View larger version (129K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —48-year-old man with chronic pancreatitis and 2- to 3-day history of abdominal pain. Axial late arterial phase contrast-enhanced CT scan (A) and volume-rendered image (B) show 3 x 2.5 cm partially thrombosed pseudoaneurysm (arrow) adjacent to tail of pancreas, probably secondary to previous pancreatitis. Pseudoaneurysm was treated by interventional coil embolization.

View larger version (130K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —48-year-old man with chronic pancreatitis and 2- to 3-day history of abdominal pain. Axial late arterial phase contrast-enhanced CT scan (A) and volume-rendered image (B) show 3 x 2.5 cm partially thrombosed pseudoaneurysm (arrow) adjacent to tail of pancreas, probably secondary to previous pancreatitis. Pseudoaneurysm was treated by interventional coil embolization.

View larger version (134K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7A —45-year-old man who presented with syncope due to spontaneous, intraperitoneal hemorrhage while exercising, source of which was not identified during surgical exploration or by postoperative CT angiography at outside institution. Axial early venous phase image (A) and sagittal multiplanar reformation (B) from IV contrast-enhanced MDCT reveal 2.5-cm aneurysm posterior to pancreas and adjacent residual retroperitoneal and intraperitoneal hemorrhage.

View larger version (135K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7B —45-year-old man who presented with syncope due to spontaneous, intraperitoneal hemorrhage while exercising, source of which was not identified during surgical exploration or by postoperative CT angiography at outside institution. Axial early venous phase image (A) and sagittal multiplanar reformation (B) from IV contrast-enhanced MDCT reveal 2.5-cm aneurysm posterior to pancreas and adjacent residual retroperitoneal and intraperitoneal hemorrhage.

View larger version (118K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7C —45-year-old man who presented with syncope due to spontaneous, intraperitoneal hemorrhage while exercising, source of which was not identified during surgical exploration or by postoperative CT angiography at outside institution. Axial oblique volume rendering from superior viewing orientation shows relationship of pseudoaneurysm to splenic artery. Aneurysm and splenic artery were successfully embolized.

View larger version (135K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8A —38-year-old woman with history of chronic pancreatitis who had known pancreatic pseudocyst. Contrast-enhanced CT showed enlarging splenic artery pseudoaneurysm. Axial (A) and coronal volume rendering (B) from IV and oral contrast-enhanced venous phase MDCT reveal 4.6 x 3.3 cm heterogeneous mass (white arrows) in region of pancreatic tail. Central enhancing component is compatible with pseudoaneurysm surrounded by acute hemorrhage. In addition, elongated, enhancing region was identified extending from pseudoaneurysm into spleen (black arrows, B), which was new from previous examination and interpreted as second pseudoaneurysm. Patient underwent interventional coil embolization of pseudoaneurysm and the spleen.

View larger version (146K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8B —38-year-old woman with history of chronic pancreatitis who had known pancreatic pseudocyst. Contrast-enhanced CT showed enlarging splenic artery pseudoaneurysm. Axial (A) and coronal volume rendering (B) from IV and oral contrast-enhanced venous phase MDCT reveal 4.6 x 3.3 cm heterogeneous mass (white arrows) in region of pancreatic tail. Central enhancing component is compatible with pseudoaneurysm surrounded by acute hemorrhage. In addition, elongated, enhancing region was identified extending from pseudoaneurysm into spleen (black arrows, B), which was new from previous examination and interpreted as second pseudoaneurysm. Patient underwent interventional coil embolization of pseudoaneurysm and the spleen.

View larger version (131K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9A —70-year-old woman with pancreatic body mass on CT and MRI performed at another institution that was interpreted as probable islet cell neoplasm. Axial contrast-enhanced arterial phase CT scan (A), coronal oblique multiplanar reformation (B), coronal volume rendering (C), and axial color-coded volume rendering from superior orientation (D) show 2-cm aneurysm arising from mid portion of splenic artery and abutting pancreas. Comparison with study from 6 months earlier revealed interval enlargement. Patient was successfully treated with interventional coil embolization of proximal splenic artery and aneurysm.

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9B —70-year-old woman with pancreatic body mass on CT and MRI performed at another institution that was interpreted as probable islet cell neoplasm. Axial contrast-enhanced arterial phase CT scan (A), coronal oblique multiplanar reformation (B), coronal volume rendering (C), and axial color-coded volume rendering from superior orientation (D) show 2-cm aneurysm arising from mid portion of splenic artery and abutting pancreas. Comparison with study from 6 months earlier revealed interval enlargement. Patient was successfully treated with interventional coil embolization of proximal splenic artery and aneurysm.

View larger version (105K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9C —70-year-old woman with pancreatic body mass on CT and MRI performed at another institution that was interpreted as probable islet cell neoplasm. Axial contrast-enhanced arterial phase CT scan (A), coronal oblique multiplanar reformation (B), coronal volume rendering (C), and axial color-coded volume rendering from superior orientation (D) show 2-cm aneurysm arising from mid portion of splenic artery and abutting pancreas. Comparison with study from 6 months earlier revealed interval enlargement. Patient was successfully treated with interventional coil embolization of proximal splenic artery and aneurysm.

View larger version (64K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9D —70-year-old woman with pancreatic body mass on CT and MRI performed at another institution that was interpreted as probable islet cell neoplasm. Axial contrast-enhanced arterial phase CT scan (A), coronal oblique multiplanar reformation (B), coronal volume rendering (C), and axial color-coded volume rendering from superior orientation (D) show 2-cm aneurysm arising from mid portion of splenic artery and abutting pancreas. Comparison with study from 6 months earlier revealed interval enlargement. Patient was successfully treated with interventional coil embolization of proximal splenic artery and aneurysm.

View larger version (119K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10A —52-year-old woman with history of surgically corrected aortic coarctation and 2 months of abdominal pain and weight loss. CT performed at outside institution revealed two enhancing lesions in pancreas that were interpreted as neuroendocrine tumors. (Reprinted with permission from Horton KM, Hruban RH, Yeo C, Fishman EK. Multi-detector row CT of pancreatic islet cell tumors. RadioGraphics 2006; 26:453-464 [30]). Repeat contrast-enhanced arterial phase MDCT with axial images (A and B), axial oblique maximum intensity projection from superior orientation (C), and coronal color-coded volume renderings (D and E) reveal that lesion is actually partially calcified aneurysm arising from splenic artery and located in body of pancreas.

View larger version (122K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10B —52-year-old woman with history of surgically corrected aortic coarctation and 2 months of abdominal pain and weight loss. CT performed at outside institution revealed two enhancing lesions in pancreas that were interpreted as neuroendocrine tumors. (Reprinted with permission from Horton KM, Hruban RH, Yeo C, Fishman EK. Multi-detector row CT of pancreatic islet cell tumors. RadioGraphics 2006; 26:453-464 [30]). Repeat contrast-enhanced arterial phase MDCT with axial images (A and B), axial oblique maximum intensity projection from superior orientation (C), and coronal color-coded volume renderings (D and E) reveal that lesion is actually partially calcified aneurysm arising from splenic artery and located in body of pancreas.

View larger version (112K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10C —52-year-old woman with history of surgically corrected aortic coarctation and 2 months of abdominal pain and weight loss. CT performed at outside institution revealed two enhancing lesions in pancreas that were interpreted as neuroendocrine tumors. (Reprinted with permission from Horton KM, Hruban RH, Yeo C, Fishman EK. Multi-detector row CT of pancreatic islet cell tumors. RadioGraphics 2006; 26:453-464 [30]). Repeat contrast-enhanced arterial phase MDCT with axial images (A and B), axial oblique maximum intensity projection from superior orientation (C), and coronal color-coded volume renderings (D and E) reveal that lesion is actually partially calcified aneurysm arising from splenic artery and located in body of pancreas.

View larger version (113K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10D —52-year-old woman with history of surgically corrected aortic coarctation and 2 months of abdominal pain and weight loss. CT performed at outside institution revealed two enhancing lesions in pancreas that were interpreted as neuroendocrine tumors. (Reprinted with permission from Horton KM, Hruban RH, Yeo C, Fishman EK. Multi-detector row CT of pancreatic islet cell tumors. RadioGraphics 2006; 26:453-464 [30]). Repeat contrast-enhanced arterial phase MDCT with axial images (A and B), axial oblique maximum intensity projection from superior orientation (C), and coronal color-coded volume renderings (D and E) reveal that lesion is actually partially calcified aneurysm arising from splenic artery and located in body of pancreas.

View larger version (78K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10E —52-year-old woman with history of surgically corrected aortic coarctation and 2 months of abdominal pain and weight loss. CT performed at outside institution revealed two enhancing lesions in pancreas that were interpreted as neuroendocrine tumors. (Reprinted with permission from Horton KM, Hruban RH, Yeo C, Fishman EK. Multi-detector row CT of pancreatic islet cell tumors. RadioGraphics 2006; 26:453-464 [30]). Repeat contrast-enhanced arterial phase MDCT with axial images (A and B), axial oblique maximum intensity projection from superior orientation (C), and coronal color-coded volume renderings (D and E) reveal that lesion is actually partially calcified aneurysm arising from splenic artery and located in body of pancreas.

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