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Idiopathic Splenic Artery Pseudoaneurysm Rupture as an Uncommon Cause of Hemorrhagic Shock.

Schatz RA, Schabel S, Rockey DC - J Investig Med High Impact Case Rep (2015)

Bottom Line: He presented with acute onset altered mental status, nausea, and worsening back and abdominal pain and was found to be in hypovolemic shock.The patient was urgently stabilized until more detailed imaging could be performed, which ultimately revealed the source of blood loss and explained his rapid decompensation.He was successfully treated with arterial coiling and embolization.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.

ABSTRACT
Splenic artery pseudoaneurysms are infrequently encountered but critical to recognize. Limited literature to date describes associations with pancreatitis, trauma, and rarely peptic ulcer disease. Hemorrhage and abdominal pain are the most common manifestations. There is typically overt gastrointestinal blood loss but bleeding can also extend into the peritoneum, retroperitoneum, adjacent organs, or even a pseudocyst. Most patients with ruptured splenic artery pseudoaneurysms present with hemodynamic instability. Here, we describe a patient recovering from acute illness in the intensive care unit but with otherwise no obvious risk factors or precipitants for visceral pseudoaneurysm. He presented with acute onset altered mental status, nausea, and worsening back and abdominal pain and was found to be in hypovolemic shock. The patient was urgently stabilized until more detailed imaging could be performed, which ultimately revealed the source of blood loss and explained his rapid decompensation. He was successfully treated with arterial coiling and embolization. Thus, we herein emphasize the importance of prompt recognition of hemorrhagic shock and of aggressive hemodynamic stabilization, as well as a focused diagnostic approach to this problem with specific treatment for splenic artery pseudoaneurysm. Finally, we recommend that multidisciplinary management should be the standard approach in all patients with splenic artery pseudoaneurysm.

No MeSH data available.


Related in: MedlinePlus

Computed tomography scan of the abdomen and pelvis.(A) An axial view of a contrast-enhanced portal venous phase CT scan demonstrates a 4.5 × 2.6 cm splenic artery pseudoaneurysm (short arrow) with associated retroperitoneal and perinephric fat stranding (long arrow). A dense abdominal free-fluid collection (arrowhead), likely from hemorrhage, is present. (B) A sagittal view of a contrast-enhanced portal venous phase CT scan demonstrates the splenic artery pseudoaneurysm (short arrow), associated retroperitoneal and perinephric fat stranding (long arrow), and the free-fluid collection (arrowhead).
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fig1-2324709615577816: Computed tomography scan of the abdomen and pelvis.(A) An axial view of a contrast-enhanced portal venous phase CT scan demonstrates a 4.5 × 2.6 cm splenic artery pseudoaneurysm (short arrow) with associated retroperitoneal and perinephric fat stranding (long arrow). A dense abdominal free-fluid collection (arrowhead), likely from hemorrhage, is present. (B) A sagittal view of a contrast-enhanced portal venous phase CT scan demonstrates the splenic artery pseudoaneurysm (short arrow), associated retroperitoneal and perinephric fat stranding (long arrow), and the free-fluid collection (arrowhead).

Mentions: The patient was emergently stabilized by placement of a high-flow non-rebreather oxygen mask and volume resuscitated with 2 L of normal saline and 2 units of packed red blood cells. His vital signs rapidly normalized. Once hemodynamically stable, a computed tomography (CT) scan with contrast of the abdomen and pelvis was obtained and revealed a large left-sided retroperitoneal hematoma with a 4.5 × 2.6 cm contrast-filled structure emanating from the splenic artery consistent with a pseudoaneurysm (Figure 1A and B). Low-density perisplenic and perihepatic free fluid with further fluid extension to the right paracolic gutter and into the pelvis was also noted.


Idiopathic Splenic Artery Pseudoaneurysm Rupture as an Uncommon Cause of Hemorrhagic Shock.

Schatz RA, Schabel S, Rockey DC - J Investig Med High Impact Case Rep (2015)

Computed tomography scan of the abdomen and pelvis.(A) An axial view of a contrast-enhanced portal venous phase CT scan demonstrates a 4.5 × 2.6 cm splenic artery pseudoaneurysm (short arrow) with associated retroperitoneal and perinephric fat stranding (long arrow). A dense abdominal free-fluid collection (arrowhead), likely from hemorrhage, is present. (B) A sagittal view of a contrast-enhanced portal venous phase CT scan demonstrates the splenic artery pseudoaneurysm (short arrow), associated retroperitoneal and perinephric fat stranding (long arrow), and the free-fluid collection (arrowhead).
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2 - License 3
Show All Figures
getmorefigures.php?uid=PMC4528868&req=5

fig1-2324709615577816: Computed tomography scan of the abdomen and pelvis.(A) An axial view of a contrast-enhanced portal venous phase CT scan demonstrates a 4.5 × 2.6 cm splenic artery pseudoaneurysm (short arrow) with associated retroperitoneal and perinephric fat stranding (long arrow). A dense abdominal free-fluid collection (arrowhead), likely from hemorrhage, is present. (B) A sagittal view of a contrast-enhanced portal venous phase CT scan demonstrates the splenic artery pseudoaneurysm (short arrow), associated retroperitoneal and perinephric fat stranding (long arrow), and the free-fluid collection (arrowhead).
Mentions: The patient was emergently stabilized by placement of a high-flow non-rebreather oxygen mask and volume resuscitated with 2 L of normal saline and 2 units of packed red blood cells. His vital signs rapidly normalized. Once hemodynamically stable, a computed tomography (CT) scan with contrast of the abdomen and pelvis was obtained and revealed a large left-sided retroperitoneal hematoma with a 4.5 × 2.6 cm contrast-filled structure emanating from the splenic artery consistent with a pseudoaneurysm (Figure 1A and B). Low-density perisplenic and perihepatic free fluid with further fluid extension to the right paracolic gutter and into the pelvis was also noted.

Bottom Line: He presented with acute onset altered mental status, nausea, and worsening back and abdominal pain and was found to be in hypovolemic shock.The patient was urgently stabilized until more detailed imaging could be performed, which ultimately revealed the source of blood loss and explained his rapid decompensation.He was successfully treated with arterial coiling and embolization.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.

ABSTRACT
Splenic artery pseudoaneurysms are infrequently encountered but critical to recognize. Limited literature to date describes associations with pancreatitis, trauma, and rarely peptic ulcer disease. Hemorrhage and abdominal pain are the most common manifestations. There is typically overt gastrointestinal blood loss but bleeding can also extend into the peritoneum, retroperitoneum, adjacent organs, or even a pseudocyst. Most patients with ruptured splenic artery pseudoaneurysms present with hemodynamic instability. Here, we describe a patient recovering from acute illness in the intensive care unit but with otherwise no obvious risk factors or precipitants for visceral pseudoaneurysm. He presented with acute onset altered mental status, nausea, and worsening back and abdominal pain and was found to be in hypovolemic shock. The patient was urgently stabilized until more detailed imaging could be performed, which ultimately revealed the source of blood loss and explained his rapid decompensation. He was successfully treated with arterial coiling and embolization. Thus, we herein emphasize the importance of prompt recognition of hemorrhagic shock and of aggressive hemodynamic stabilization, as well as a focused diagnostic approach to this problem with specific treatment for splenic artery pseudoaneurysm. Finally, we recommend that multidisciplinary management should be the standard approach in all patients with splenic artery pseudoaneurysm.

No MeSH data available.


Related in: MedlinePlus