Ruptured Aneurysm of the Splenic Artery in a 90-Year-Old Man With Syncope

Abstract

A 90-year-old man was admitted to our Emergency Center with syncope and abdominal pain. We found the followng: Glasgow Coma Scale of E3V4M6, blood pressure of 74/41 m Hg, and heart rate of 80 beats/min. He underwent surgical emoval of an ascending colon carcinoma more than 10 years reviously. Abdominal muscular rigidity was evident upon deep alpitation. His hemoglobin concentration, hematocrit, and latelet levels were 8.6 g/dL (normal, 11.0 –17.0 g/dL), 26.4% normal, 34%– 49%), and 16.2 104/ L (normal, 14 –34 104/ L). Chest radiograph and electrocardiographic findings ere normal. Ultrasonography revealed fluid collection in the ntra-abdominal cavity. Multidetector-row computed tomograhy (MDCT) scanning revealed intra-abdominal fluid collection nd a round lesion that was calcified at the periphery in the natomic vicinity immediate to the pancreas (Figure A). The rterial phase MDCT images revealed a 91 80 80-mm accular splenic artery aneurysm (SAA) that directly communiated with the proximal splenic artery (SA) (Figure B). Although he venous phase MDCT images revealed homogeneous spleen enhancement, the distal SA was not clearly enhanced. Multiplanar reconstruction images further revealed that the SAA was partially thrombosed and that the occluded distal SA had collapsed. Angiography revealed a large SAA with high blood flow, which also was detected by Doppler ultrasonography as swirling flow into the SAA after CT scanning. None of the images revealed dilation or disruption of the layers of arterial wall (Figures C and D). The spleen already was supplied by the left gastric artery. Arterial embolization of the proximal SA was successful, and SAA was undetectable thereafter (Figure E). The absence of flow via collateral arteries into the SAA and an intact