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DOI: 10.1055/s-0029-1243940
© Georg Thieme Verlag KG Stuttgart · New York
Diagnosis of a small splenic artery aneurysm mimicking a gastric submucosal tumor on endoscopic ultrasound
K. AkahoshiMD, PhD
Department of Gastroenterology
Aso Iizuka Hospital
3-82 Yoshio
Iizuka 820-8505
Japan
Fax: +81-948-298747
Email: kakahoshi2@aol.com
Publication History
Publication Date:
19 March 2010 (online)
Although extrinsic compression of the gastric wall by an intact splenic artery is a common observation, the characteristic endoscopic ultrasound (EUS) findings of small splenic artery aneurysm (SAA) have not yet been established.
We present four symptom-free patients who were diagnosed as having extragastric compression from a small SAA in the early stage, at the posterior wall of the fundus, by EUS. [Table 1] summarizes the clinical characteristics of the patients and the findings of the various investigations. All patients underwent esophagogastroduodenoscopy (EGD), EUS using an electronic radial scanning echoendoscope (EG-530UR, Fujifilm Corp., Saitama, Japan) with color and power Doppler flow-mapping capabilities, and three-dimensional spiral computed tomographic angiography (3D-CTA) using intravenous contrast agents. The final diagnosis was based on the EUS and 3D-CTA findings and the results of the clinical follow-up (5 – 16 months, mean 12 months).
Patient (age in years/sex) | Symptoms | EGD findings | EUS findings | 3D-CTA findings | |||||
Doppler Pulse-wave | |||||||||
SDS | CGW | Size, mm | Site | Form | Size, mm | ||||
1 (53/F) | None | SMT | + | + | 10 | Arterial pattern | Hilum | Saccular | 10 |
2 (64/M) | None | SMT | + | + | 15 | Arterial pattern | Hilum | Saccular | 15 |
3 (58/F) | None | SMT | + | + | 11 | Arterial pattern | Hilum | Saccular | 10 |
4 (57/F) | None | SMT | + | + | 10 | Arterial pattern | Hilum | Saccular | 10 |
SMT, submucosal tumor; SDS, segmental dilatation of the splenic artery; CGW, compression of the gastric wall |
Screening EGD seemed to reveal a submucosal tumor on the posterior wall of the fundus in all the patients ([Fig. 1]). However, EUS revealed a normal gastric wall compressed by a focally dilated aneurysm ([Fig. 2]), and an arterial pulsation signal was detected by pulse-wave Doppler ultrasound ([Fig. 3]). 3D-CTA revealed these submucosal masses to be small SAAs. Patient 2 had an aneurysm (15-mm diameter) at the hilum of the splenic artery ([Fig. 4]). There was no change in the SAAs in any of the patients at a 3-month follow-up with 3D-CT.
SAA is the most common visceral artery aneurysm [1] [2], and although asymptomatic when small, 3 % – 10 % of SAAs are at risk for rupture [3] [4]. Aneurysms should be considered in the differential diagnosis of endoscopically detected submucosal lesions to avoid potentially harmful outcomes of EUS-guided fine needle aspiration or biopsy. EUS may be a reliable initial diagnostic modality for the diagnosis of even small SAAs (≤ 15-mm diameter), primarily to differentiate between true submucosal tumors and extrinsic compression of the gastric wall caused by normal or pathological structures.
Competing interests: None
Endoscopy_UCTN_Code_CCL_1AF_2AD
#References
- 1 Deterling Jr R A. Aneurysm of the visceral arteries. J Cardiovasc Surg. 1971; 12 309-322
- 2 Dave S P, Reis E D, Hossain A. et al . Splenic artery aneurysm in the 1990s. Ann Vasc Surg. 2000; 14 223-229
- 3 Stanley J C, Fry W J. Pathogenesis and clinical significance of splenic artery aneurysms. Surgery. 1974; 76 898-909
- 4 Trastek V F, Pairolero P C, Joyce J W. Splenic artery aneurysms. Surgery. 1982; 91 694-699
K. AkahoshiMD, PhD
Department of Gastroenterology
Aso Iizuka Hospital
3-82 Yoshio
Iizuka 820-8505
Japan
Fax: +81-948-298747
Email: kakahoshi2@aol.com
References
- 1 Deterling Jr R A. Aneurysm of the visceral arteries. J Cardiovasc Surg. 1971; 12 309-322
- 2 Dave S P, Reis E D, Hossain A. et al . Splenic artery aneurysm in the 1990s. Ann Vasc Surg. 2000; 14 223-229
- 3 Stanley J C, Fry W J. Pathogenesis and clinical significance of splenic artery aneurysms. Surgery. 1974; 76 898-909
- 4 Trastek V F, Pairolero P C, Joyce J W. Splenic artery aneurysms. Surgery. 1982; 91 694-699
K. AkahoshiMD, PhD
Department of Gastroenterology
Aso Iizuka Hospital
3-82 Yoshio
Iizuka 820-8505
Japan
Fax: +81-948-298747
Email: kakahoshi2@aol.com