Images in vascular medicine Splenic artery aneurysm

A 69-year-old white male, with a history of hypertension and hypercholesterolemia, presented with a complaint of left, lower quadrant, abdominal pain that radiated to the back, which he had suffered for 2 weeks. The discomfort was most prominent in the seated position and improved with standing or lying down. An abdominal CT scan revealed a 4-cm diameter splenic artery aneurysm (Panel A; arrow). A subsequent angiogram conŽ rmed the presence of a fusiform splenic artery aneurysm measuring 4 cm at its greatest diameter and beginning just distal to the splenic artery origin at the celiac axis (left arrow) and extending to the level of the splenic hilum (right arrow) (Panel B). The patient underwent successful operative obliteration of the aneurysm and splenectomy, since the aneurysm extended into the splenic hilum. Splenic artery aneurysm is rare, with an incidence ranging from 1.6% in an unselected autopsy population to 7.1% in autopsies performed on patients with cirrhotic portal hypertension. However, splenic artery aneurysm is the the most common aneurysm of the visceral arteries, with an average size of 2.10 cm but rarely exceeding 3 cm. Two factors contributing to its formation are weakness of the arterial wall and a concomitant rise in blood pressure. The arterial wall is sensitive to the hormonal effects and hemodynamic stresses of pregnancy, especially in multiparous women and those with pre-existing Ž bromuscular dysplasia. Atherosclerosis may occur and is thought to be a Department of Medicine, Cardiovascular Division and Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, USA