Some cases on splanchnic vessel aneurysm detected first by ultrasound and confirmed later via MDCT 64. Color ultrasound could reveal abdominal vessel aneurysm but was difficult for B-mode ultrasound.

1. Splanchnic Vessel AneurysmsSplanchnic Vessel Aneurysms ::
Ultrasound FindingsUltrasound Findings
in Combining with MSCT 64in Combining with MSCT 64
in Vietnamin Vietnam..
Nguyen Thien HungNguyen Thien Hung - Le van Tai - Le Thanh Liem- Le van Tai - Le Thanh Liem
- Nguyen Vinh Thinh – Tran Minh Dung - Phan Thanh Hai- Nguyen Vinh Thinh – Tran Minh Dung - Phan Thanh Hai
Medic Medical Center, Ho Chi Minh City,Medic Medical Center, Ho Chi Minh City,
Vietnam.Vietnam.

3. Splanchnic Artery AneurysmsSplanchnic Artery Aneurysms
Shabana F. PashaShabana F. Pasha,, Peter GloviczkiPeter Gloviczki,, Anthony W. StansonAnthony W. Stanson,,
Patrick S. KamathPatrick S. Kamath
AbstractAbstract
 Autopsy : splanchnic artery aneurysms moreAutopsy : splanchnic artery aneurysms more
frequent than abdominal aortic aneurysms.frequent than abdominal aortic aneurysms.
 Important to recognize = up to 25% may beImportant to recognize = up to 25% may be
ruptured, (mortality rate after rupture = 25% andruptured, (mortality rate after rupture = 25% and
70%).70%).
 However, little is known about the natural historyHowever, little is known about the natural history
and clinical presentation of splanchnic arteryand clinical presentation of splanchnic artery
aneurysms.aneurysms.

4. Splanchnic Artery AneurysmsSplanchnic Artery Aneurysms
Shabana F. PashaShabana F. Pasha,, Peter GloviczkiPeter Gloviczki,, Anthony W. StansonAnthony W. Stanson,,
Patrick S. KamathPatrick S. Kamath
 Splenic artery aneurysms are the most common;Splenic artery aneurysms are the most common;
multiple aneurysms = 1/3 of patients.multiple aneurysms = 1/3 of patients.
 Hepatic artery pseudoaneurysms are moreHepatic artery pseudoaneurysms are more
common than true aneurysmscommon than true aneurysms
because of increasing numbers of hepatobiliarybecause of increasing numbers of hepatobiliary
interventional procedures.interventional procedures.

5. Splanchnic Artery AneurysmsSplanchnic Artery Aneurysms
Shabana F. PashaShabana F. Pasha, Peter Gloviczki, Anthony W. Stanson,, Peter Gloviczki, Anthony W. Stanson,
Patrick S. KamathPatrick S. Kamath
The diagnosis of splanchnic artery aneurysm should beThe diagnosis of splanchnic artery aneurysm should be
considered inconsidered in
 any patient with abdominal pain,any patient with abdominal pain,
 a pulsatile mass,a pulsatile mass,
 or an abdominal bruitor an abdominal bruit
 with or without associated bleeding.with or without associated bleeding.
However, most aneurysms are asymptomaticHowever, most aneurysms are asymptomatic
and are detected incidentallyand are detected incidentally
on imaging studies.on imaging studies.

6. Splanchnic Artery AneurysmsSplanchnic Artery Aneurysms
Shabana F. PashaShabana F. Pasha, Peter Gloviczki, Anthony W. Stanson,, Peter Gloviczki, Anthony W. Stanson,
Patrick S. KamathPatrick S. Kamath
Treatment, which can be either surgical or interventional radiology-Treatment, which can be either surgical or interventional radiology-
based, should be considered inbased, should be considered in
 all patients with symptoms related to the aneurysms,all patients with symptoms related to the aneurysms,
 if the aneurysm is more than 2 cm in diameter,if the aneurysm is more than 2 cm in diameter,
 if the patient is pregnant,if the patient is pregnant,
 or if there is demonstrated growth of the aneurysm.or if there is demonstrated growth of the aneurysm.
----------------------------------------------------------------
Source: Mayo Clin Proc. 2007;82:472-479.Source: Mayo Clin Proc. 2007;82:472-479.

7. Distribution of splanchnic artery aneurysms (AA).
Pasha S F et al. Mayo Clin Proc. 2007;82:472-479
© 2007 Mayo Foundation for Medical Education and Research

8. Purpose:Purpose:
Splanchnic vessel aneurysms are rare conditions andSplanchnic vessel aneurysms are rare conditions and
possible having severe complications: rupture,possible having severe complications: rupture,
thrombus, organ ischemia, but could be disclosed inthrombus, organ ischemia, but could be disclosed in
their asymptomatic status by some modalities oftheir asymptomatic status by some modalities of
diagnostic imaging : Doppler ultrasound and multislicediagnostic imaging : Doppler ultrasound and multislice
CT (MSCT).CT (MSCT).
Our report aims to evaluate the abilities of ultrasoundOur report aims to evaluate the abilities of ultrasound
in detecting some splanchnic vessel aneurysms inin detecting some splanchnic vessel aneurysms in
routine examination and confirming that by MSCT.routine examination and confirming that by MSCT.

9. ObjectivesObjectives::
Having by chance some asymptomatic aneurysms ofHaving by chance some asymptomatic aneurysms of
hepatic artery (post cholecystectomy),hepatic artery (post cholecystectomy),
gastroepiploic artery,gastroepiploic artery,
celiac artery,celiac artery,
gastroduodenal artery,gastroduodenal artery,
portal vein (extrahepatic and intrahepatic),portal vein (extrahepatic and intrahepatic),
superior mesenteric artery,superior mesenteric artery,
splenic artery and splenic vein,splenic artery and splenic vein,
intrarenal artery,intrarenal artery,
by ultrasound and confirmed them by MSCT later.by ultrasound and confirmed them by MSCT later.
Most of cases were in watched and follow-up studiesMost of cases were in watched and follow-up studies
and no one in rupture after discovering.and no one in rupture after discovering.

10. Hepatic Artery AneurysmHepatic Artery Aneurysm
Post endoscopic cholecystectomy for
one month, a 44yo female patient got
hematemesis and epigastric pain. US
revealed an 1cm mass with yingyan
sign. MSCT confirmed an hepatic
artery aneurysm.

11. Hepatic Artery AneurysmHepatic Artery Aneurysm

12. Gastroepiploic Artery AneurysmGastroepiploic Artery Aneurysm
Having turbulent flow, a #26x27x30mm gastroepiploic artery aneurysm which
was connected a branch of hepatic artery, was nearby superior mesenteric
artery.

13. Gastroepiploic Artery AneurysmGastroepiploic Artery Aneurysm

14. Coeliac trunk aneurysm with turbulent flow.
CELIAC ARTERY ANEURYSM

15. CELIAC ARTERY ANEURYSM

16. CELIAC ARTERY ANEURYSM

18. EXTRAHEPATIC PORTAL VEIN ANEURYSMEXTRAHEPATIC PORTAL VEIN ANEURYSM

19. Superior Mesenteric Artery AneurysmSuperior Mesenteric Artery Aneurysm
Aneurysm of SMA # 53mm with turbulent flow.

20. Superior Mesenteric Artery AneurysmSuperior Mesenteric Artery Aneurysm

21. Left Portal Vein AneurysmLeft Portal Vein Aneurysm
Left branch of portal vein : a venous aneurysm # 26x29x27mm, thin
wall with turbulent spectral flow .

22. Left Portal Vein AneurysmLeft Portal Vein Aneurysm

23. Splenic Vein AneurysmSplenic Vein Aneurysm
Cystic lesion #45x39mm, yinyang sign (+), venous spectral pattern
nearby the spleen hilus.

24. Splenic Vein AneurysmSplenic Vein Aneurysm

25. Intrarenal Artery AneurysmIntrarenal Artery Aneurysm
Intrarenal cystic lesion # 25mm with arterial spectral pattern.

26. Intrarenal Artery AneurysmIntrarenal Artery Aneurysm

27. Discussions:Discussions:
Ultrasound B-mode in some cases could notUltrasound B-mode in some cases could not
characterize completely the nature of splanchniccharacterize completely the nature of splanchnic
aneurysm but could show theaneurysm but could show the vascular wallvascular wall andand
dimensionsdimensions..
It was more sensitive to detect splanchnic vesselIt was more sensitive to detect splanchnic vessel
aneurysms with color Doppler imaging technique inaneurysms with color Doppler imaging technique in
presenting thepresenting the direction of blood flowdirection of blood flow andand turbulencesturbulences..

28. Discussions (cont.):Discussions (cont.):
Meanwhile with MSCT Angiography theMeanwhile with MSCT Angiography the
characterization of splanchnic vessel aneurysmscharacterization of splanchnic vessel aneurysms
was more perfect and more reliable in their 3Dwas more perfect and more reliable in their 3D
reconstruction images.reconstruction images.
But color ultrasound could be the first choice toBut color ultrasound could be the first choice to
disclose and follow-up splanchnic vesseldisclose and follow-up splanchnic vessel
aneurysms in our Vietnam country.aneurysms in our Vietnam country.
..

29. Conclusions:Conclusions:
Color ultrasound could be the screeningColor ultrasound could be the screening
method to detect early asymptomaticmethod to detect early asymptomatic
splanchnic vessel aneurysms by combining ansplanchnic vessel aneurysms by combining an
advanced technique as MSCT, and follow-upadvanced technique as MSCT, and follow-up
in Vietnam.in Vietnam.