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Splenic Artery Pseudoaneurysm Rupture
Authors:
Michelle Kurian Solik, MS, MD, and Wesley Prichard, DO
St. Vincent Hospital, Indianapolis, Indiana
Citation:
Solik MK, Prichard W. Splenic artery pseudoaneurysm rupture. Consultant. 2018;58(7):e195.
A 56-year-old man presented to an outside hospital for evaluation of sudden-onset abdominal pain and lightheadedness. He had a history of hypertension, which was well-controlled, and of mechanical mitral valve repair for nonrheumatic mitral valve prolapse, for which he was on warfarin therapy. He described the abdominal pain as dull and largely left-sided, primarily underneath his ribs. He denied having any nausea, vomiting, diarrhea, back pain, fever, or chills.
Upon arrival to the outside hospital, the patient was hypotensive, with a systolic blood pressure of 74 mm Hg; this improved to the low 90s mm Hg with aggressive fluid resuscitation. A computed tomography (CT) scan with contrast of the abdomen and pelvis completed at the outside hospital revealed evidence of pancreatitis. Findings of abdominal ultrasonography were unremarkable, and the patient’s lipase level, lactate level, white blood cell count, and comprehensive metabolic panel results were within normal limits. He was transferred to our tertiary care center for further management of pancreatitis.
Physical examination. Upon arrival to our institution, it was apparent that there was contradiction between the symptoms that the patient was reporting, our physical examination findings, and the clinical data that thus far had been collected. Abdominal examination findings were largely unimpressive for someone with pancreatitis; the patient denied having any lower back pain, nausea, or vomiting; and results of a repeated lipase test were within normal limits.
The CT images done at the outside hospital were reviewed by a radiologist at our facility; upon closer inspection, the fluid that originally had been mistaken for evidence of postinflammatory changes associated with pancreatitis was actually evidence of blood accumulation likely related to a splenic artery aneurysm rupture (Figure).
Figure. CT of the abdomen and pelvis with contrast showed evidence of pancreatic inflammation, but also a large accumulation of blood surrounding the body and tail of the pancreas, representing pseudoaneurysm rupture. No obvious splenomegaly was noted.
NEXT: Diagnostic Tests
Authors:
Michelle Kurian Solik, MS, MD, and Wesley Prichard, DO
St. Vincent Hospital, Indianapolis, Indiana
Citation:
Solik MK, Prichard W. Splenic artery pseudoaneurysm rupture. Consultant. 2018;58(7):e195.
A 56-year-old man presented to an outside hospital for evaluation of sudden-onset abdominal pain and lightheadedness. He had a history of hypertension, which was well-controlled, and of mechanical mitral valve repair for nonrheumatic mitral valve prolapse, for which he was on warfarin therapy. He described the abdominal pain as dull and largely left-sided, primarily underneath his ribs. He denied having any nausea, vomiting, diarrhea, back pain, fever, or chills.
Upon arrival to the outside hospital, the patient was hypotensive, with a systolic blood pressure of 74 mm Hg; this improved to the low 90s mm Hg with aggressive fluid resuscitation. A computed tomography (CT) scan with contrast of the abdomen and pelvis completed at the outside hospital revealed evidence of pancreatitis. Findings of abdominal ultrasonography were unremarkable, and the patient’s lipase level, lactate level, white blood cell count, and comprehensive metabolic panel results were within normal limits. He was transferred to our tertiary care center for further management of pancreatitis.
Physical examination. Upon arrival to our institution, it was apparent that there was contradiction between the symptoms that the patient was reporting, our physical examination findings, and the clinical data that thus far had been collected. Abdominal examination findings were largely unimpressive for someone with pancreatitis; the patient denied having any lower back pain, nausea, or vomiting; and results of a repeated lipase test were within normal limits.
The CT images done at the outside hospital were reviewed by a radiologist at our facility; upon closer inspection, the fluid that originally had been mistaken for evidence of postinflammatory changes associated with pancreatitis was actually evidence of blood accumulation likely related to a splenic artery aneurysm rupture (Figure).
Figure. CT of the abdomen and pelvis with contrast showed evidence of pancreatic inflammation, but also a large accumulation of blood surrounding the body and tail of the pancreas, representing pseudoaneurysm rupture. No obvious splenomegaly was noted.
