S3566 Spontaneous Celiac Artery Aneurysm in a Healthy Young Male

Abstract

INTRODUCTION: Celiac artery aneurysms (CAA) are an uncommon form of splanchnic aneurysms, accounting for about 5.1% of cases, and typically effect older males with atherosclerotic disease. Aneurysmal rupture carries a mortality rate of 25–70% with a risk of rupture of 5% with aneurysms 15 mm–22 mm in diameter and a risk of rupture of 50–70% when an aneurysm is greater than 30 mm. Etiology of CAA include atherosclerosis, infectious, trauma, segmental arterial mediolysis (SAM), etc. Below we present an unusual case of a spontaneous CAA in healthy young male with a negative rheumatologic workup and no history of atherosclerosis. CASE DESCRIPTION/METHODS: A 39-year-old male without significant past medical history presented to the ED with five days of bilateral upper quadrant abdominal pain. Initial labs were unremarkable. A computerized tomography (CT) scan of the abdomen and pelvis with contrast was ordered, which showed a 1.1 cm fusiform CAA with a short segment dissection flap, and abnormal wall thickening of the celiac, splenic and proximal common hepatic arteries suggestive of vasculitis (Image 1). Labs showed mildly elevated C-reactive protein of 15.2 mg/L, erythrocyte sedimentation rate of 44 mm/hr, and total complement level >60 U/mL. With the presumptive diagnosis of vasculitis, the patient was started on bowel rest, intravenous methylprednisone and a heparin drip with resolution of his symptoms. The follow-up rheumatological workup for antibodies including antineutrophil cytoplasmic, proteinase 3, myeloperoxidase, anti-nuclear, mitochondrial, and smooth muscle were negative. The patient was started on aspirin 81 mg daily, clopidogrel 75 mg daily and a prednisone taper on discharge. The aneurysm was stable on repeat imaging one month later. DISCUSSION: This is an unusual case of a spontaneous CAA with dissection in an otherwise healthy young male. He was successfully treated with antiplatelet agents and steroids for an underlying vasculitis. CAAs can rupture into the peritoneal cavity thus urgent CT imaging with contrast enhancement in the arterial phase is essential if suspected. Furthermore, CAA can cause extrinsic compression of splenic vessels and hepatic or portal obstruction which can lead to end-organ infarction. Elective endovascular or surgical repair should be considered in low-risk patients with greater than 2 cm or rapidly expanding aneurysms. It is important to keep visceral artery aneurysm on the differential with patients presenting with abdominal pain as the consequences can be grave.Image 1.: CT scan of the abdomen and pelvis with contrast showed a 1.1 cm fusiform CAA with a short segment dissection flap, and abnormal wall thickening of the celiac, splenic and proximal common hepatic arteries suggestive of vasculitis.