Advertisement

Vascular Pathology of the Spleen

  • C. C. Hoeffel
Part of the Medical Radiology book series (MEDRAD)

Abstract

This chapter refers to lesions involving the splenic vessels and to the consequent splenic parenchymal pathology of such lesions. Splenic vessels include the splenic vein and the splenic artery. The splenic vein is a thin-walled vein coursing in a groove along the upper dorsal surface of the pancreas and is formed by the union of four or five branches leaving the splenic hilum. Occasionally, a vein from the upper pole of the spleen joins the splenic vein more proximally (the superior polar vein). Proximally, the splenic vein receives the short gastric veins and the gastroepiploic vein from the stomach. It receives multiple pancreatic branches and the inferior me- senteric vein as it passes posterior to the tail and body of the pancreas. The splenic vein then unites with the superior mesenteric vein to form the portal vein behind the neck of the pancreas. The splenic vessels pass towards the spleen in the phrenicosplenic and lienorenal ligaments. The splenic artery arises from the coeliac trunk and enters the spleen as four or five branches at the hilum between the gastric and renal impressions.

Keywords

Portal Hypertension Splenic Artery Splenic Vein Gastric Varix Splenic Infarction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Adler DD, Glazer GM, Aisen AM (1986) MRI of the spleen: normal appearance and findings in sickle-cell anemia. AJR Am J Roentgenol 147:843–845PubMedGoogle Scholar
  2. Angelakis EJ, Bair WE, Barone JE, et al. (1993) Splenic artery aneurysm rupture during pregnancy. Obstet Gynecol Surg 48:145–148CrossRefGoogle Scholar
  3. Avery GR, Wilsdon JB, Mitchell L (1991) Case report: CT and angiographic appearances of intrasplenic mycotic aneurysm. Clin Radiol 44:271–272PubMedCrossRefGoogle Scholar
  4. Baker KS, Tisnado J, Cho SR, et al. (1987) Splanchnic artery aneurysms and pseudoaneurysms: transcatheter embolization. Radiology 163:135–139PubMedGoogle Scholar
  5. Balcar I, Seltzer SE, Davis S, et al. (1984) CT patterns of splenic infarction: a clinical and experimental study. Radiology 151:723–729PubMedGoogle Scholar
  6. Balthazar EJ, Megibow A, Naidich D, et al. (1984) Computed tomographic recognition of gastric varices. AJR Am J Roentgenol 142:1121–1125PubMedGoogle Scholar
  7. Balthazar EJ, Hilton S, Naidich D, et al. (1985) CT of splenic and perisplenic abnormalities in septic patients. AJR Am J Roentgenol 144:53–56PubMedGoogle Scholar
  8. Bedford BT, Lodge B (1960) Aneurysms of the splenic artery. Gut 1:312–320PubMedCrossRefGoogle Scholar
  9. Bishop NL (1984) Splenic artery aneurysm rupture into the colon diagnosed by angiography. Br J Radiol 57:1149–1150PubMedCrossRefGoogle Scholar
  10. Burke JW, Erickson SJ, Kellum CD, et al. (1986) Pseudoaneurysms complicating pancreatitis: detection by CT. Radiology 161:447–450PubMedGoogle Scholar
  11. Busuttil RW, Brin BJ (1980) The diagnosis and management of visceral artery aneurysms. Surgery 88:619–624PubMedGoogle Scholar
  12. Cantarero JM, Llorente JG, Hidalgo EG, et al. (1989) Splenic arteriovenous fistula: diagnosis by duplex Doppler sonography. AJR Am J Roentgenol 153:1313–1314PubMedGoogle Scholar
  13. Carr SC, Pearce WH, Vogelzang RL, et al. (1996) Current management of visceral artery aneurysms. Surgery 120:627–634PubMedCrossRefGoogle Scholar
  14. Derchi LE, Biggi E, Cicio GR, et al. (1984) Aneurysms of the splenic artery: non-invasive diagnosis by pulsed Doppler sonography. J Ultrasound Med 3:41–44PubMedGoogle Scholar
  15. Dochez C, De Roy G (1970) Calcification of the spleen. Fortschr Geb Rontgenstr Nuklearmed 112:274–275PubMedCrossRefGoogle Scholar
  16. Fava C, Grosso M, Spalluto F, et al. (1990) Percutaneous treatment of splenic arteriovenous fistula. Description of a case. Radiol Med (Torino) 80:559–562Google Scholar
  17. Fishmann EK, Wyatt SH, Ney DR, et al. (1992) Spiral CT of the pancreas with multiplanar display. AJR Am J Roentgenol 159:1209–1215Google Scholar
  18. Fishmann EK, Soyer P, Bliss DF, et al. (1995) Splenic involvement in pancreatitis: spectrum of CT findings. AJR Am J Roentgenol 164:631–635Google Scholar
  19. Gartside R, Gamelli RL (1987) Splenic arteriovenous fistula. J Trauma 27:671–673PubMedCrossRefGoogle Scholar
  20. Goerg C, Schwerk WB (1990) Splenic infarction: sonographic patterns, diagnosis, follow-up, and complications. Radiology 174:803–807PubMedGoogle Scholar
  21. Goletti O, Ghiselli G, Lippolis PV, et al. (1996) Intrasplenic posttraumatic pseudoaneurysm: echo colour Doppler diagnosis. J Trauma 41:542–545PubMedCrossRefGoogle Scholar
  22. Golzarian J, Braude P, Bank WO, et al. (1994) Case report: colour Doppler demonstration of pseudoaneurysms complicating pancreatic pseudocysts. Br J Radiol 67:91–93PubMedCrossRefGoogle Scholar
  23. Gudmundsen TE, Lie M, Ostensen H (1988) Splenic arteriovenous fistula. Case report. Eur J Surg 154:603–604Google Scholar
  24. Hashizume M, Ohta M, Ueno K, et al. (1993) Laparoscopic ligation of splenic artery aneurysm. Surgery 113:352–354PubMedGoogle Scholar
  25. Ishida H, Konno K, Hamashima Y,et al. (1998) Splenic artery aneurysm: value of colour doppler and the limitation of gray-scale ultrasonography. Abdom Imaging 23:627–632PubMedCrossRefGoogle Scholar
  26. Jaroch MT, Broughan TA, Hermann RE (1986) The natural history of splenic infarction. Surgery 100:743–750PubMedGoogle Scholar
  27. Kauzlaric D, Passega E (1986) Atypical sonographic findings in splenic infarction. J Clin Ultrasound 14:461–462PubMedCrossRefGoogle Scholar
  28. Kehagias DT, Tzalonikos MT, Moulopoulos LA, et al. (1998) MRI of a giant splenic artery aneurysm. Br J Radiol 71:444–446PubMedGoogle Scholar
  29. Kelekis D, Brountzos EN, Kelekis N, et al. (1995) Splenic aneurysm with arteriovenous fistula. A case report. Hepatogastroenterology 42:352–355PubMedGoogle Scholar
  30. Magid D, Fishman EK, Siegelman SS (1984) Computed tomography of the spleen and liver in sickle cell disease. AJR Am J Roentgenol 143:245–249PubMedGoogle Scholar
  31. Mandel SR, Jacques PF, Sanofsky S, et al. (1987) Non-operative management of peripancreatic arterial aneurysms. A 10-year experience. Ann Surg 205:126–128PubMedCrossRefGoogle Scholar
  32. Marn CS, Glazer GM, Williams DM, et al. (1990) CT-angiographic correlation of collateral venous pathways in isolated splenic vein occlusion: new observations. Radiology 175:375–380PubMedGoogle Scholar
  33. Mattar SG, Lumsden AB (1995) The management of splenic artery aneurysms: experience with 23 cases. Am J Surg 169:580–584PubMedCrossRefGoogle Scholar
  34. McClary D, Finelli DS, Croker B, et al. (1986) Portal hypertension secondary to a spontaneous splenic arteriovenous fistula: case report and review of the literature. Am J Gastroenterol 81:572–575PubMedGoogle Scholar
  35. McDermott VG, Shlansky-Goldberg R, Cope C (1994) Endovascular management of splenic artery aneurysms and pseudoaneurysms. Cardiovasc Intervent Radiol 17:179–184PubMedCrossRefGoogle Scholar
  36. Minami, Itai J, Ohtomo K, et al. (1989) Siderotic nodules in the spleen. MR imaging of portal hypertension. Radiology 172:681–684PubMedGoogle Scholar
  37. Murayama S, Shimoda Y (1990) Completely thrombosed splenic artery aneurysm mimicking cystic pancreatic mass: computed tomographic findings. Gastrointest Radiol 15:205–206PubMedCrossRefGoogle Scholar
  38. Nishida O, Moriyasu F, Nakamura T, et al. (1986) Hemodynamics of splenic artery aneurysm. Gastroenterology 90:1042–1046PubMedGoogle Scholar
  39. Ohta M, Hashizume M, Tanoue K, et al. (1992) Splenic hyperkinetic state and splenic artery aneurysm in portal hypertension. Hepatogastroenterology 39:529–532PubMedGoogle Scholar
  40. Petit P, Bret P, Atri M, et al. (1994) Splenic vein thrombosis after splenectomy: frequency and role of imaging. Radiology 190:65–68PubMedGoogle Scholar
  41. Piscaglia F, Valgimigli M, Serra C, et al. (1998) Duplex Doppler findings in splenic arteriovenous fistula. J Clin Ultrasound 26:103–105PubMedCrossRefGoogle Scholar
  42. Puttini M, Aseni P, Brambilla G, et al. (1982) Splenic artery aneurysms in portal hypertension. J Cardiovasc Surg Torino 23:490–493PubMedGoogle Scholar
  43. Quinn SF, Van Sonnenberg E, Casola G, et al. (1986) Interventional radiology of the spleen. Radiology 161:289–291PubMedGoogle Scholar
  44. Rabushka LS, Kawashima A, Fishman EK (1994) Imaging of the spleen: CT with supplemental MR examination. Radiographics 14:307–332PubMedGoogle Scholar
  45. Rahmouni A, Mathieu D, Golli M, et al. (1992) Value of CT and sonography in the conservative management of acute splenoportal and superior mesenteric venous thrombosis. Gastrointest Radiol 17:135–140PubMedCrossRefGoogle Scholar
  46. Reidy JF, Rowe PH, Ellis FG (1990) Splenic artery aneurysm embolisation. The preferred technique to surgery. Clin Radiol 41:281–282PubMedCrossRefGoogle Scholar
  47. Roshkow JE, Sanders LM (1990) Acute splenic sequestration crisis in two adults with sickle cell disease: US, CT, and MR imaging findings. Radiology 177:723–725PubMedGoogle Scholar
  48. Rypens F, Devière J, Zalcman M, et al. (1997) Splenic parenchymal complications of pancreatitis: CT findings and natural history. J Comput Assist Tomogr 21:89–93PubMedCrossRefGoogle Scholar
  49. Sarioglu A, Tanyel FC, Ariyurek M, et al. (1995) Aneurysmatic arteriovenous fistula complicating splenic injury. Eur J Pediatr Surg 6:183–185CrossRefGoogle Scholar
  50. Shleapnik M, Shpitz B, Siegal A, et al. (1990) Bleeding oesophageal varices and portal hypertension caused by arteriovenous fistula of splenic artery. HPB Surg 3:53–57PubMedCrossRefGoogle Scholar
  51. Short DH, Puyau MK, Sauls JL, et al. (1985) Use of digital subtraction angiography in the diagnosis of splenic artery aneurysms. Am Surg 51:606–608PubMedGoogle Scholar
  52. Stallard DJ, Tu RK, Gould MJ, et al. (1994) Minor vascular anatomy of the abdomen and pelvis: a CT atlas. Radiographics 14:493–513PubMedGoogle Scholar
  53. Trastek VF, Pairolero PC, Joyce JW, et al. (1982) Splenic artery aneurysms. Surgery 91:694–699PubMedGoogle Scholar
  54. Venbrux AC, Dachman AH, Fishman EK (1993) Friedman AC (eds) Radiology of the spleen. Mosby Year Book, St. Louis, pp 171–Google Scholar
  55. Vujic I (1989) Vascular complications of pancreatitis. Radiol Clin North Am 27:81–91PubMedGoogle Scholar
  56. Walker TG, Geller SC, Waltman AC (1988) Splenic artery pseudoaneurysms causing lower gastrointestinal hemorrhage. AJR Am J Roentgenol 150:433–434PubMedGoogle Scholar
  57. Weingarten MJ, Fakhry J, MacCarthy J, et al. (1984) Sonography after splenic embolization: the wedge-shaped acute infarct. AJR Am J Roentgenol 142:957–959PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2000

Authors and Affiliations

  • C. C. Hoeffel
    • 1
  1. 1.Department of Radiology AHôpital COCHINParisFrance

Personalised recommendations