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A rare case of non-traumatic intrasplenic pseudoaneurysms in a patient with acute T-cell lymphoblastic leukemia

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Abstract

Pseudoaneurysm (PSA) or false aneurysm is a vascular lesion resulting from a focal and incomplete rupture of the arterial wall (intimate and/or elastic lamina), that allows blood to escape into the arterial wall; this small contained break causes a contained collection of blood and the creation of a “new” less resistant vessel wall, consisting of adventitia and perivascular tissues. Intrasplenic pseudoaneurysms are rare and more frequently recognize traumatic origin, sometimes are also unexpected lesions due to non-recent trauma. In contrast, non-traumatic intrasplenic pseudoaneurysms are rare complications usually due to splenic infarction, infiltration by malignant systemic disorders, infectious process, chronic pancreatitis, and arteritis. Both traumatic and non-traumatic PSA are potentially life threatening, known to cause spontaneous rupture of the spleen with massive hemoperitoneum. Contrast-enhanced CT is the gold standard technique to detect splenic PSA; however, it is important to know how to recognize it also with other imaging methods such as with ultrasound (US) and contrast-enhanced ultrasound (CEUS). US and CEUS can be often the first-line diagnostic techniques and allow to detect these lesions; they are also very useful in the follow-up. Our case report can be a reminder of the utility of the US and CEUS in detecting splenic pseudoaneurysms, which are potentially a life-threatening complication; we also recall the semiotics of these lesions with baseline ultrasound (US), color Doppler US and contrast-enhanced ultrasound (CEUS). Then, we highlight the role of contrast-enhanced CT in confirming the diagnosis and we report about the diagnostic and therapeutic value of angiography. We have to think about the possibility of a pseudoaneurysm even in the absence of a recent trauma, associated with other conditions such as a lymphoproliferative disease.

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Authors and Affiliations

  1. Department of Emergency Radiology, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy

    Margherita Trinci, Carlo Giangregorio, Giovanna Calabrese, Pierfrancesco Ottaviani & Michele Galluzzo

  2. Department of Interventional Radiology, Azienda Ospedaliera S. Camillo-Forlanini, Rome, Italy

    Pascale Riu

  3. Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, L.go Giovanni Alessandro Brambilla, 3, 50134, Florence, Italy

    Vittorio Miele

Authors
  1. Margherita Trinci
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  2. Carlo Giangregorio
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  3. Giovanna Calabrese
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  4. Pierfrancesco Ottaviani
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  5. Pascale Riu
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  6. Michele Galluzzo
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  7. Vittorio Miele
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Correspondence to Vittorio Miele.

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Trinci, M., Giangregorio, C., Calabrese, G. et al. A rare case of non-traumatic intrasplenic pseudoaneurysms in a patient with acute T-cell lymphoblastic leukemia. J Ultrasound 24, 85–90 (2021). https://doi.org/10.1007/s40477-019-00401-5

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  • DOI: https://doi.org/10.1007/s40477-019-00401-5

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