Splanchnic Vessel Aneurysms in Vietnam

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Some cases on splanchnic vessel aneurysm detected first by ultrasound and confirmed later via MDCT 64. Color ultrasound could reveal abdominal vessel aneurysm but was difficult for B-mode ultrasound.

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  • Distribution of splanchnic artery aneurysms (AA). Prevalence (percentage of all splanchnic artery aneurysms) and sites of splanchnic artery aneurysms are indicated.
  • Splanchnic Vessel Aneurysms in Vietnam

    1. 1. Splanchnic Vessel AneurysmsSplanchnic Vessel Aneurysms ::Ultrasound FindingsUltrasound Findingsin Combining with MSCT 64in Combining with MSCT 64in Vietnamin Vietnam..Nguyen Thien HungNguyen Thien Hung - Le van Tai - Le Thanh Liem- Le van Tai - Le Thanh Liem- Nguyen Vinh Thinh – Tran Minh Dung - Phan Thanh Hai- Nguyen Vinh Thinh – Tran Minh Dung - Phan Thanh HaiMedic Medical Center, Ho Chi Minh City,Medic Medical Center, Ho Chi Minh City,Vietnam.Vietnam.
    2. 2. Splanchnic Artery AneurysmsSplanchnic Artery AneurysmsShabana F. PashaShabana F. Pasha,, Peter GloviczkiPeter Gloviczki,, Anthony W. StansonAnthony W. Stanson,,Patrick S. KamathPatrick S. KamathAbstractAbstract Autopsy : splanchnic artery aneurysms moreAutopsy : splanchnic artery aneurysms morefrequent than abdominal aortic aneurysms.frequent than abdominal aortic aneurysms. Important to recognize = up to 25% may beImportant to recognize = up to 25% may beruptured, (mortality rate after rupture = 25% andruptured, (mortality rate after rupture = 25% and70%).70%). However, little is known about the natural historyHowever, little is known about the natural historyand clinical presentation of splanchnic arteryand clinical presentation of splanchnic arteryaneurysms.aneurysms.
    3. 3. Splanchnic Artery AneurysmsSplanchnic Artery AneurysmsShabana F. PashaShabana F. Pasha,, Peter GloviczkiPeter Gloviczki,, Anthony W. StansonAnthony W. Stanson,,Patrick S. KamathPatrick S. Kamath Splenic artery aneurysms are the most common;Splenic artery aneurysms are the most common;multiple aneurysms = 1/3 of patients.multiple aneurysms = 1/3 of patients. Hepatic artery pseudoaneurysms are moreHepatic artery pseudoaneurysms are morecommon than true aneurysmscommon than true aneurysmsbecause of increasing numbers of hepatobiliarybecause of increasing numbers of hepatobiliaryinterventional procedures.interventional procedures.
    4. 4. Splanchnic Artery AneurysmsSplanchnic Artery AneurysmsShabana F. PashaShabana F. Pasha, Peter Gloviczki, Anthony W. Stanson,, Peter Gloviczki, Anthony W. Stanson,Patrick S. KamathPatrick S. KamathThe diagnosis of splanchnic artery aneurysm should beThe diagnosis of splanchnic artery aneurysm should beconsidered inconsidered in any patient with abdominal pain,any patient with abdominal pain, a pulsatile mass,a pulsatile mass, or an abdominal bruitor an abdominal bruit with or without associated bleeding.with or without associated bleeding.However, most aneurysms are asymptomaticHowever, most aneurysms are asymptomaticand are detected incidentallyand are detected incidentallyon imaging studies.on imaging studies.
    5. 5. Splanchnic Artery AneurysmsSplanchnic Artery AneurysmsShabana F. PashaShabana F. Pasha, Peter Gloviczki, Anthony W. Stanson,, Peter Gloviczki, Anthony W. Stanson,Patrick S. KamathPatrick S. KamathTreatment, which can be either surgical or interventional radiology-Treatment, which can be either surgical or interventional radiology-based, should be considered inbased, should be considered in all patients with symptoms related to the aneurysms,all patients with symptoms related to the aneurysms, if the aneurysm is more than 2 cm in diameter,if the aneurysm is more than 2 cm in diameter, if the patient is pregnant,if the patient is pregnant, or if there is demonstrated growth of the aneurysm.or if there is demonstrated growth of the aneurysm.----------------------------------------------------------------Source: Mayo Clin Proc. 2007;82:472-479.Source: Mayo Clin Proc. 2007;82:472-479.
    6. 6. Distribution of splanchnic artery aneurysms (AA).Pasha S F et al. Mayo Clin Proc. 2007;82:472-479© 2007 Mayo Foundation for Medical Education and Research
    7. 7. Purpose:Purpose:Splanchnic vessel aneurysms are rare conditions andSplanchnic vessel aneurysms are rare conditions andpossible having severe complications: rupture,possible having severe complications: rupture,thrombus, organ ischemia, but could be disclosed inthrombus, organ ischemia, but could be disclosed intheir asymptomatic status by some modalities oftheir asymptomatic status by some modalities ofdiagnostic imaging : Doppler ultrasound and multislicediagnostic imaging : Doppler ultrasound and multisliceCT (MSCT).CT (MSCT).Our report aims to evaluate the abilities of ultrasoundOur report aims to evaluate the abilities of ultrasoundin detecting some splanchnic vessel aneurysms inin detecting some splanchnic vessel aneurysms inroutine examination and confirming that by MSCT.routine examination and confirming that by MSCT.
    8. 8. ObjectivesObjectives::Having by chance some asymptomatic aneurysms ofHaving by chance some asymptomatic aneurysms ofhepatic artery (post cholecystectomy),hepatic artery (post cholecystectomy),gastroepiploic artery,gastroepiploic artery,celiac artery,celiac artery,gastroduodenal artery,gastroduodenal artery,portal vein (extrahepatic and intrahepatic),portal vein (extrahepatic and intrahepatic),superior mesenteric artery,superior mesenteric artery,splenic artery and splenic vein,splenic artery and splenic vein,intrarenal artery,intrarenal artery,by ultrasound and confirmed them by MSCT later.by ultrasound and confirmed them by MSCT later.Most of cases were in watched and follow-up studiesMost of cases were in watched and follow-up studiesand no one in rupture after discovering.and no one in rupture after discovering.
    9. 9. Hepatic Artery AneurysmHepatic Artery AneurysmPost endoscopic cholecystectomy forone month, a 44yo female patient gothematemesis and epigastric pain. USrevealed an 1cm mass with yingyansign. MSCT confirmed an hepaticartery aneurysm.
    10. 10. Hepatic Artery AneurysmHepatic Artery Aneurysm
    11. 11. Gastroepiploic Artery AneurysmGastroepiploic Artery AneurysmHaving turbulent flow, a #26x27x30mm gastroepiploic artery aneurysm whichwas connected a branch of hepatic artery, was nearby superior mesentericartery.
    12. 12. Gastroepiploic Artery AneurysmGastroepiploic Artery Aneurysm
    13. 13. Coeliac trunk aneurysm with turbulent flow.CELIAC ARTERY ANEURYSM
    14. 14. CELIAC ARTERY ANEURYSM
    15. 15. CELIAC ARTERY ANEURYSM
    16. 16. EXTRAHEPATIC PORTAL VEIN ANEURYSMEXTRAHEPATIC PORTAL VEIN ANEURYSM
    17. 17. Superior Mesenteric Artery AneurysmSuperior Mesenteric Artery AneurysmAneurysm of SMA # 53mm with turbulent flow.
    18. 18. Superior Mesenteric Artery AneurysmSuperior Mesenteric Artery Aneurysm
    19. 19. Left Portal Vein AneurysmLeft Portal Vein AneurysmLeft branch of portal vein : a venous aneurysm # 26x29x27mm, thinwall with turbulent spectral flow .
    20. 20. Left Portal Vein AneurysmLeft Portal Vein Aneurysm
    21. 21. Splenic Vein AneurysmSplenic Vein AneurysmCystic lesion #45x39mm, yinyang sign (+), venous spectral patternnearby the spleen hilus.
    22. 22. Splenic Vein AneurysmSplenic Vein Aneurysm
    23. 23. Intrarenal Artery AneurysmIntrarenal Artery AneurysmIntrarenal cystic lesion # 25mm with arterial spectral pattern.
    24. 24. Intrarenal Artery AneurysmIntrarenal Artery Aneurysm
    25. 25. Discussions:Discussions:Ultrasound B-mode in some cases could notUltrasound B-mode in some cases could notcharacterize completely the nature of splanchniccharacterize completely the nature of splanchnicaneurysm but could show theaneurysm but could show the vascular wallvascular wall andanddimensionsdimensions..It was more sensitive to detect splanchnic vesselIt was more sensitive to detect splanchnic vesselaneurysms with color Doppler imaging technique inaneurysms with color Doppler imaging technique inpresenting thepresenting the direction of blood flowdirection of blood flow andand turbulencesturbulences..
    26. 26. Discussions (cont.):Discussions (cont.):Meanwhile with MSCT Angiography theMeanwhile with MSCT Angiography thecharacterization of splanchnic vessel aneurysmscharacterization of splanchnic vessel aneurysmswas more perfect and more reliable in their 3Dwas more perfect and more reliable in their 3Dreconstruction images.reconstruction images.But color ultrasound could be the first choice toBut color ultrasound could be the first choice todisclose and follow-up splanchnic vesseldisclose and follow-up splanchnic vesselaneurysms in our Vietnam country.aneurysms in our Vietnam country...
    27. 27. Conclusions:Conclusions:Color ultrasound could be the screeningColor ultrasound could be the screeningmethod to detect early asymptomaticmethod to detect early asymptomaticsplanchnic vessel aneurysms by combining ansplanchnic vessel aneurysms by combining anadvanced technique as MSCT, and follow-upadvanced technique as MSCT, and follow-upin Vietnam.in Vietnam.

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