Splenic Artery Aneurysm in Extrahepatic Portal Vein Obstruction - CT Angio

Axial thick MIP image of CT angiography showing aneurysm arising from the main splenic artery

Coronal thick MIP image of CT angiography showing aneurysm arising from the main splenic artery

3 D volume rendering image of CT angiography showing aneurysm arising from the main splenic artery (arrow).

Axial CT image in venous phase showing multiple collateral veins in the porta with non visualised main portal vein consistent with extra heaptic portal vein obstruction. Note splenomegaly and multiple leinorenal collaterals.

Discussion:

Splenic artery aneurysms (SAA) are the most common visceral aneurysm occuring predominantly in females. SAA causing EHPVO and presenting with features of portal hypertension is extremely rare.

Women are affected four times more commonly by SAA and often during pregnancy and childbearing years due to endocrine changes.

The usual location of splenic artery aneurysm is at the mid or distal portion of the splenic artery, frequently found at the arterial bifurcation.

Clinical features: They are usually asymptomatic, and the symptomatic presentation includes chronic abdominal pain of varied severity or an acute rupture with hypotension.

Radiology:
CT angiography is the best modality for the diagnosis, although it is usually detected incidentally.

Treatment:
Endovascular: Coiling or covered stent.
Operative: Aneursyectomy with or without splenectomy.