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. 2018 Feb 1;10(1):5.
doi: 10.1186/s13089-018-0086-3.

Acute fissuration of a giant splenic artery aneurysm detected by point-of-care ultrasound: case report

Philippe Le Conte  1 , David Trewick  2 , Philippe Pes  2 , Eric Frampas  3 , Eric Batard  2 ; Winfocus-France Group
Affiliations

Acute fissuration of a giant splenic artery aneurysm detected by point-of-care ultrasound: case report

Philippe Le Conte et al. Crit Ultrasound J. .

Abstract

Background: Epigastric pain is frequent in Emergency Medicine and remains a challenging situation. Besides benign etiologies such as gastritis or uncomplicated cholelithiasis, it could reveal myocardial infarction or vascular disease. Point-of-care ultrasound (POCUS) could be performed in such situation.

Case presentation: A healthy 66-year-old man with no previous medical history was admitted to the Emergency Department for a rapid onset epigastric pain. He reported taking non-steroidal anti-inflammatories for 1 week prior to admission. His pain had rapidly subsided and the physical examination was inconclusive. ECG and blood samples were normal. POCUS revealed a vascular mass located between the spleen and the left kidney measuring 80 * 74 mm associated with small amounts of free peritoneal fluid. Computed tomography diagnosed a fissurated giant aneurysm of the splenic artery. The aneurysm was managed emergently by endovascular exclusion by selective splenic artery embolization. The post-intervention course was uneventful and the patient was discharged home 3 days later. The patient has remained free from any complications of the embolization 6 months after the procedure.

Conclusion: Spontaneously regressive epigastric pain with a normal physical and biology/ECG should not necessarily reassure the physician, in particular if patients have cardiovascular risk factors. A POCUS should be considered for these patients.

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Figures

Fig. 1
Fig. 1
POCUS scan of the left upper quadrant of a patient presenting with epigastric pain. See the vascular mass located between spleen and kidney
Fig. 2
Fig. 2
POCUS color Doppler scan of left upper quadrant in a patient presenting an epigastric pain. See the strong Doppler signal
Fig. 3
Fig. 3
Axial arterial phase contrast-enhanced MDCT. Maximal Intensity Projection view: Giant calcified aneurysm of the splenic artery
Fig. 4
Fig. 4
Axial portal venous phase contrast-enhanced MDCT. Hemoretroperitoneum (white arrows)
Fig. 5
Fig. 5
Axial portal venous phase contrast-enhanced MDCT. Pelvic hemoperitoneum (white arrow)
Fig. 6
Fig. 6
Splenic angiography. Morphological aspect of the aneurysm
See this image and copyright information in PMC

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