Splenic artery aneurysm
- The most common visceral arterial aneurysm, and the third most common abdominal aneurysm (after aorta and iliac vessels)
- Etiologies include arterial fibrodysplasia, portal hypertension, and increased splenic AV shunting in pregnancy
- Incidence on CT = 0.8%
- Female:Male 4:1
- 2% result in life-threatening rupture
- Increase risk of rupture in pregnancy (most commonly in 3rd trimester). 
- Thought to be secondary to increase in estrogen, progesterone and relaxin causing aneurysmal dilatation.
- High maternal and fetal mortality post-rupture
- Typically asymptomatic or vague with left upper quadrant pain with radiation to the left shoulder or subscapular area (most are incidental CT finding)
- May have epigastric/abdominal pain and/or hemodynamic instability if ruptured
- Calcified left adrenal haematoma
- Other causes of hemoperitoneum if ruptured
- Ruptured ectopic pregnancy
- CTA Abdomen/Pelvis is the gold standard
- Initial FAST exam may show fluid in left upper quadrant if ruptured aneurysm
- Surgery and/or IR consult
- Ruptured aneurysm requires emergent laparotomy or endovascular intervention
- Aneurysm size <2cm, asymptomatic, and hemodynamically stable
- Follow-up with PCP and/or vascular surgery for surveillance scans at 6 months and then every 1-2 years.
- Aneurysm of any size in symptomatic patients, cirrhotic patients undergoing liver transplant, patients with α-1 antitrypsin deficiency, and patients who are pregnant or of childbearing age (requires consultation with a vascular surgeon for ligation or embolization)
- Aneurysm size >2cm (Requires consult with a vascular surgeon for ligation or embolization)
- Khosa, Faisal, MD. "Managing Incidental Findings on Abdominal and Pelvic CT and MRI, Part 2: White Paper of the ACR Incidental Findings Committee II on Vascular Findings." Journal of the American College of Radiology 10.10 (2013): 789-94.
- Parrish J, Maxwell C, Beecroft J. Splenic Artery Aneurysm in Pregnancy. JOGC. 2015; 37(9):816–818.
- Casadei R. et al. Thrombosed splenic artery aneurysm simulating a pancreatic body mass: can two entities be distinguished preoperatively thus avoiding diagnostic and therapeutic mistakes? JOP 2007;8:235–9
- Lakin, Ryan O., MD. "The Contemporary Management of Splenic Artery Aneurysms." Journal of Vascular Surgery 53.4 (2011): 1157.