11
Spleen
Splenic Artery Aneurysm
Overview
Most common visceral artery aneurysm
Third most common intra-abdominal aneurysm after abdominal aortic aneurysm and iliac artery aneurysm
Risk factors include collagen vascular disorder, portal hypertension, pregnancy, trauma, pancreatitis, and fibrodysplasia
Signs and Symptoms
Mostly asymptomatic
May have vague left upper quadrant or epigastric pain
If ruptured, patient will display signs of hypovolemic shock along with abdominal distension
Diagnosis
CT angiography, MRI/MRA, or abdominal ultrasound
Treatment/Management
Operative management if ≥2 cm, pregnancy, anticipated pregnancy, pseudoaneurysm, expanding aneurysm, or if patient is symptomatic
Operative management includes aneurysmectomy, partial splenectomy, endovascular embolization, or stent graft exclusion of the aneurysm
RADIOLOGY
Plain film findings
• Splenic artery calcifications may be seen in the left upper quadrant
CT findings (Fig. 11.1)
• Focal dilation of the splenic artery, usually containing wall calcifications
• Enhancement equal to that of the aorta
• May contain mural thrombus
FIGURE 11.1 A–F
A. Liver
B. Kidney
C. Spleen
D. Descending aorta
E. Vertebra
FIGURE 11.1 A
FIGURE 11.1 B
FIGURE 11.1 C
FIGURE 11.1 D
FIGURE 11.1 E
FIGURE 11.1 F
Splenic Cyst
Overview
Categorized into the following:
• Nonparasitic cyst (two types):
Congenital—true epidermoid cyst (has an epithelial lining)
Pseudocyst—acquired from trauma
• Parasitic cyst: From echinococcal infection
Signs and Symptoms
Typically asymptomatic and found incidentally
If cyst is large enough, patient will experience abdominal pain with left-sided scapular or shoulder pain, early satiety, nausea or vomiting, weight loss
Diagnosis
Ultrasound—can establish the presence of a cystic lesion
CT—nonenhancing cystic lesion within the spleen
Peripheral or septal calcifications may be seen
Serology for echinococcal antibodies
Treatment/Management
Nonparasitic cysts
• Asymptomatic—observation
• Symptomatic—unroofing, partial splenectomy
Parasitic cyst—splenectomy
• Avoid spillage of cyst contents intraoperatively (results in anaphylactic shock)
RADIOLOGY
Plain film findings (Fig. 11.2 D)
• May see a calcifications outlining the cyst
US findings (Fig. 11.2 E)
• Pseudocysts may show internal echoes from debris
• Pseudocysts may show echogenic foci with posterior acoustic shadowing due to calcification
CT findings (Fig. 11.2 A,B,C)
• Homogeneous, well-circumscribed, fluid attenuation
• No internal enhancement
• Cyst wall calcification may be present
• May contain internal septations
MRI findings
• Homogeneous, well-circumscribed, T2 hyperintense due to fluid
• Pseudocysts have variable signal intensity on T1-weighted images due to the presence of blood or proteinaceous material
FIGURE 11.2 A–E
A. Liver
B. Spleen
C. Vertebra
D. Kidney
E. Psoas muscle
F. Stomach
G. Descending aorta
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