彩色多普勒血流显像诊断脾动脉瘤的价值

目的探讨脾动脉瘤的彩色多普勒血流显像（CDFI）表现及其诊断价值。方法回顾性分析15例脾动脉瘤患者的超声结果，包括二维及彩色多普勒血流显像表现。结果在15例脾动脉瘤患者中，单发13例，多发2例（各2个瘤体），共17个瘤体。瘤体位于脾动脉近段3个，中段1个，远段（脾门处）13个。二维超声表现为：脾动脉呈囊状扩张的无回声，直径2．0～5．5cm，平均3．6cm。CDFI显示无回声两端与脾动脉相连，内充满彩色血流信号，呈涡流，其内引出动脉血流频谱。4例合并附壁血栓，壁上可见低回声，CDFI见该处血流信号充盈缺损。CDFI诊断准确率88．2％（15／17），1例误诊为左侧肾上腺肿瘤；1例多发脾动脉瘤的2个瘤体中，超声诊断1个，漏诊1个。结论脾动脉瘤多数单发，且多位于脾动脉远段。CDFI诊断准确性较高，可以作为脾动脉瘤首选影像学检查及随诊方法，其主要诊断依据为瘤体内充满动脉血流信号或充盈缺损，两端与脾动脉相连。     

Hemosuccus pancreaticus: diagnosis with CT and MRI and treatment with transcatheter embolization

We report the case of a 56-year-old woman with a presyncopal episode followed by melena. A sentinel clot sign in the pancreatic duct on precontrast computed tomography and the presence of a splenic artery aneurysm on postcontrast computed tomography strongly suggested a fistula between the aneurysm and the duct, as visualized by magnetic resonance imaging. The patient was treated successfully by complete embolization of the splenic artery aneurysm. Received: 25 January 2000/Accepted: 21 February 2001     

Completely thrombosed splenic artery aneurysm mimicking cystic pancreatic mass: Computed tomographic findings

A case of a completely thrombosed aneurysm of the splenic artery is reported. The central lumen of the aneurysm was not enhanced on computed tomography (CT); therefore, a cystic pancreatic mass could not be excluded. This entity should be considered in the differential diagnosis when a cystic peripancreatic mass with a calcified rim is detected on CT.     

Spontaneous rupture of intrahepatic artery aneurysm with complicated vascular anomalies

An 18-year-old man developed a sudden onset of upper abdominal pain with vomiting. Ul-trasound and computed tomographic (CT) scans revealed the spontaneous rupture of an intrahepatic artery aneurysm with subcapsular hematoma. A celiac arteriogram demonstrated a ruptured intrahepatic artery aneurysm in the right lobe of the liver, right extrahepatic artery aneurysm, obliteration of gastroduodenal artery, and abnormal flow pattern of the splenic artery. Portal vein phase, using superior mesenteric arteriography, showed portal vein varices and obliteration of the portal trunk. A right hepatic lobectomy was performed. The cut surface of the resected liver revealed a ruptured intrahepatic artery aneurysm with massive hematoma.     

Rupture of a Splenic Artery Aneurysm in the First Trimester of Pregnancy

Background: Rupture of a splenic artery aneurysm during pregnancy is a rare and serious event, occurring mainly during the third trimester. The risk of rupture for an existing splenic artery aneurysm is very high during pregnancy (from 20% to 50%). When it does rupture, the maternal mortality rate is around 75% and the fetal mortality rate 95%. Of 110 cases reported in the literature, only one ruptured during the first trimester. Objectives: The aim of this case report is to make emergency physicians aware of this diagnosis, because only if it is considered can it be managed rapidly and appropriately. Case Report: We report the case of a 6-weeks pregnant patient referred to our institution in hemorrhagic shock who died of a ruptured splenic artery aneurysm shortly after surgery. The initial diagnosis considered was a ruptured ectopic pregnancy. Conclusion: We report this case to increase awareness of splenic artery rupture during pregnancy, even during the first trimester.     

Splenic artery aneurysm: value of color Doppler and the limitation of gray-scale ultrasonography

Background: To reevaluate the advantages and limitations of gray-scale and color Doppler sonography in the diagnosis of splenic artery (Sp-A) aneurysm. Methods: We reviewed the gray-scale and color Doppler sonograms of five cases with Sp-A aneurysm (four patients with portal hypertension and one patient without portal hypertension). Color Doppler sonography was performed in all five patients, and power Doppler sonography was performed in three. Results: Gray-scale sonography failed to detect the aneurysm in four of five cases because of a surrounding splenorenal (Sp-R) shunt in three patients and marked calcification of the aneurysmal wall in one patient. Pulsed Doppler sonography showed a slightly turbulent pulsatile flow along the aneurysmal wall, which immediately led to the diagnosis in four cases, including the three cases with Sp-R shunt. In one case, color Doppler sonography failed to detect the aneurysm because of a markedly calcified aneurysmal wall, although power Doppler sonography could visualize the aneurysm. Conclusions: Gray-scale sonography is not a useful diagnostic tool for Sp-A aneurysm. Clinicians should use color Doppler sonography in the evaluation of the splenic hilus in patients with Sp-R shunt to find a small Sp-A aneurysm. The addition of power Doppler sonography is helpful in visualizing calcified Sp-A aneurysms.     

Aneurysmal dilatation of the portal vein: A case diagnosed by real-time ultrasonography

A case of aneurysmal dilatation of the portal vein is reported. A real-time ultrasound study showed a cystic mass behind the pancreatic head, freely communicating with the lumen of the portal, superior mesenteric, and splenic veins, which was diagnostic of portal vein aneurysm. The diagnosis was confirmed by dynamic computed tomography and celiac and superior mesenteric angiograms.     

Laparoscopic resection for splenic artery aneurysm using the lateral approach: Report of two cases

We report two cases of successful laparoscopic surgery for splenic artery aneurysm. In case 1, a 59‐year‐old man who had hypertension was admitted to the hospital with complaints of slight back pain. CT scan showed a winding splenic artery and an aneurysm behind the pancreas body. In case 2, a 71‐year‐old woman with hypertension consulted us and was diagnosed with splenic artery aneurysm. Her aneurysm increased from 1.2 mm to 20 mm at the 1‐year follow‐up. In both cases, we performed laparoscopic splenectomy, using the left lateral approach, to resect the aneurysm. Splenectomy was performed after the spleen had changed color. The operating times were 210 and 259 min, respectively and the bleeding was 60 and 100 mL, respectively. The postoperative course was uneventful. By using the lateral approach from the left side, we were able to precisely resect the splenic artery aneurysm under a stable laparoscopic view.     

Massive upper gastrointestinal haemorrhage due to intragastric rupture of a splenic artery aneurysm

Most cases of splenic artery aneurysm are asymptomatic, being found incidentally at the time of investigations (e.g. ultrasound, computed tomography, angiography) or laparotomy for other conditions. Rupture of a splenic artery aneurysm with erosion into the stomach is a rare cause of massive upper gastrointestinal haemorrhage. This case report is, to our knowledge, only the second case of splenic artery aneurysm presenting with massive upper gastrointestinal haemorrhage due to erosion into the stomach in a nulliparous woman.     

Laparoscopic approaches for splenic artery aneurysms

Abstract Background: Therapeutic options for splenic artery aneurysm include endovascular management, laparoscopic surgery, and open surgery, although their indications and applications as standard therapy remain controversial. Methods: Between August 2009 and March 2011, three patients with splenic artery aneurysm were treated at our institution. All patients underwent laparoscopic surgery. Results: There was no conversion to open surgery. The mean operative time was 204.7 min (range: 147-265 min) and the mean intraoperative blood loss was 30 mL (range: 0-90 mL). There was no mortality or morbidity. Conclusions: The laparoscopic approaches for splenic artery aneurysm were safe procedures.     

Aneurysm of the splenic artery: rupture in pregnancy

The rupture of a splenic artery aneurysm during pregnancy is a rare event. Two thirds of all ruptures happen during the third trimester. We report a case of a patient at 39 weeks of gestation suffering from abdominal pain and fetal distress. At cesarean delivery an aneurysm of the splenic artery was found to be the reason for the hematoperitoneum. Spleen, aneurysm and the tail of the pancreas were removed. The patient and her infant survived without further damage. Increased blood flow and changes in the vascular wall put pregnant women at risk for rupture of an aneurysm. In case of acute abdominal pain accompanied by progressive hypotension in a pregnant patient, a rupture of the splenic artery has to be considered. Active management and operation are the most important procedures for diagnosis and therapy of the bleeding. Abdominal delivery will help to establish diagnosis and should be performed immediately.     

Pseudoaneurysm in a chronic pancreatitis patient: report of a case,with emphasis on contrast-enhanced sonograms

The association between pseudoaneurysm of the splenic artery and pancreatitis is now established. Rupture of an aneurysm is a lethal condition, and early diagnosis and treatment are required to prevent this hazardous life-threatening complication. In our case, early detection of pseudoaneurysm of the splenic artery enabled us to start prompt embolization, which yielded good results. Splenic infarction is known to be an important and frequent complication of transarterial embolization of splenic artery aneurysms. Thus, when performing transarterial embolization of a splenic artery aneurysm, this complication must be kept in mind and it is absolutely necessary to confirm the presence or absence of this complication after embolization of the aneurysm. In our case of pseudoaneurysm of the splenic artery due to acute aggravation of chronic pancreatitis, contrast-enhanced ultrasonography confirmed the spleen to be free from infarction. Thus, this technique is strongly recommended in such instances.     

Regression of splenic vein aneurysm following resolution of splenomegaly

Aneurysms of the portal venous structures have rarely been reported. We present a case of a splenic vein aneurysm that appeared and regressed in parallel with splenic size during the course of a systemic infection in a patient with leukemia. The aneurysm was demonstrated with B-mode and color Doppler sonography and computed tomography. After appropriate therapy, the spleen diminished in size. This decrease was accompanied by regression of the aneurysm. Color Doppler sonography enables the noninvasive detection, diagnosis, and follow-up of splenic vein aneurysms. © 1998 John Wiley & Sons, Inc. J Clin Ultrasound 26 : 98–102, 1998.     

Varix of the fetal intra-abdominal umbilical vein: comparison with normal.

To compare the normal extrahepatic portion of the fetal intra-abdominal umbilical vein (FIUV) with varix of the FIUX, we prospectively measured the diameter of the FIUV in 150 uncomplicated second and third trimester pregnancies and compared these results with retrospective review of nine fetuses with varix of the FIUV as an isolated prenatal sonographic finding. The diameter of the normal FIUV increases linearly from approximately 3 mm at 15 menstrual weeks to approximately 8 mm at term (R = 0.92). The nine fetuses with FIUV varix had a FIUV diameter 6 to 12 standard deviations above the mean for age. Four (44%) of the nine fetuses with FIUV varix subsequently died, including one with trisomy 21. One of the remaining fetuses developed severe hydrops 2 weeks after the initial detection of the FIUV varix. FIUV varix appears to carry an increased risk of adverse fetal outcome, including fetal demise.     

Splenic vein aneurysm with calcification of splenic and portal veins

Splenic vein aneurysm is a rare disease, and calcifications in the portal venous system are also rare. Here we present a case of splenic vein aneurysm associated with calcification of the splenic and portal veins, a condition that to our knowledge has not been reported before.     

多层螺旋CT对活体肾移植供体术前综合评价的初步研究

目的评价MSCT在活体肾供体术前综合评价中的价值。方法11例供体术前进行了MSCT三期增强扫描,均进行VR及MIP重组,观察肾实质、肾动脉、肾静脉以及集尿系统,并与9例手术结果进行对照分析。结果MSCTA显示23支肾动脉,包括左肾副动脉1例;23支肾静脉,包括1例左双肾静脉;23支肾盂输尿管,包括1例右侧双肾盂双输尿管。此外,还检出副肝静脉2例,脾动脉瘤1例。2例放弃手术,1例因肾血管原因,1例为乙肝病毒携带者;9例手术结果与MSCT所见完全吻合,准确率为100%。结论MSCT作为术前活体肾供体的一站式检查技术,有重要的临床应用价值。     

Laparoscopic distal pancreatectomy for hemosuccus pancreaticus due to an intraductal papillary mucinous neoplasm

Hemosuccus pancreaticus (HP) is a condition that is defined as gastrointestinal hemorrhage which occurs through the pancreatic duct. We present the rare case of a 75-year-old woman who developed HP caused by intraductal papillary mucinous neoplasm (IPMN). She had been followed for sarcoidosis, splenic artery aneurysm and pancreatic cyst. The patient presented to the emergency room of our hospital with epigastric pain and bloody discharge. Computed tomography revealed hemorrhage from a splenic artery aneurysm in a cystic lesion of the pancreas. On angiography, extravasation from the splenic artery was observed. Thus, we performed coil embolization. After interventional radiography (IVR), magnetic resonance imaging and endoscopic retrograde pancreatography showed a branch duct IPMN. Based on these findings, elective laparoscopic distal pancreatectomy was performed. The histopathological diagnosis was IPMN with HP caused by rupture of a splenic artery aneurysm. For such complicated cases, minimally invasive surgery is applicable after successful hemostasis by IVR.     

MSCT平扫诊断下肢静脉曲张

目的 探讨256层MSCT平扫评价下肢静脉曲张的价值。方法 收集临床拟诊下肢静脉曲张患者40例,所有患者行下肢静脉的256层MSCT平扫+增强扫描,以CT增强为对照,评价CT平扫对下肢浅静脉曲张的检出情况。以患者临床体表征象为参照标准,评估单纯CT平扫图像对于皮肤表面显示不明显的皮下曲张静脉（即隐匿曲张静脉）的检出情况。结果 CT平扫评价曲张浅静脉与CT增强符合率为100%（54/54）,CT增强提示隐匿曲张静脉发生率为16.20%（35/216）,CT平扫图像显示隐匿曲张静脉与CT增强的符合率为100%（35/35）。结论 CT平扫对下肢浅静脉曲张的诊断价值与增强相似,对无法行CT增强扫描的患者,CT平扫可部分替代增强扫描。     

Detection of anomalous splenic artery aneurysms with three-dimensional contrast-enhanced MR angiography

Background

Aneurysms of the splenic artery which arise anomalously from the superior mesenteric artery are extremely rare but clinically important because of their life-threatening hemorrhage. Diagnostic imaging plays an important role in the diagnosis and conducting treatment strategy. The aim of this study was to evaluate the detection of anomalous splenic artery aneurysms with 3D contrast-enhanced MR angiography.

Methods

3D contrast-enhanced MR angiography was performed in six patients with anomalous splenic artery aneurysms.

Results

The mean diameter of six aneurysms was 3.9 cm. All of them were saccular and located at the origin of the splenic artery that arose anomalously from the root of the superior mesenteric artery. 3D contrast-enhanced MR angiography clearly demonstrated the aneurysm’s location, size, morphology, visceral arterial variations, and was superior to DSA in three-dimensional display of the aneurysm and its relationship with surrounding vessels and organs. Two patients underwent open vascular surgery and three endovascular procedure.

Conclusion

3D contrast-enhanced MR angiography is a noninvasive and accurate technique for diagnosis of anomalous splenic artery aneurysms. Its 3D anatomic information is very helpful for treatment planning. It can be used as one of the first choice examinations for anomalous splenic artery aneurysms.     

MSCTA在诊断内脏动脉瘤中的临床应用价值

目的 探讨多层螺旋CT血管造影（MSCTA）在诊断内脏动脉瘤中的临床价值.方法 回顾性分析42例内脏动脉瘤患者的CT增强扫描资料,采用容积重组（VR）＂血管生长＂技术（AV）、多平面重建（MPR）行血管重建.结果 42例患者中,共发现58个动脉瘤,均清晰显示动脉瘤与载瘤动脉的关系,其中脾动脉瘤27个（46.6%）,肝动脉瘤6个（10.3%）,肾动脉瘤10个（17.2%）,肠系膜动脉瘤7个（12.1%）,腹腔动脉瘤8个（13.8%）,3个破裂（5.2%）,8个合并显示载瘤动脉狭窄（13.8%）.结论 MSCTA能准确诊断内脏动脉瘤及伴发或继发性改变.