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Schlängelung und Verkalkung der Milzarterie im Röntgenbild

Mehr als ein Nebenbefund

Tortuosity and calcification of the splenic artery

More than an additional finding

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Zusammenfassung

Die Schlängelung der Milzarterie und Verkalkungen in der Wand des Gefäßes sind ein typischer Nebenbefund bei der Röntgenuntersuchung des Abdomens. Die Kombination wird v. a. bei Senioren beobachtet, ohne dass Symptome einer Mangelperfusion der Milz fassbar sind. Bei der Pathogenese wirken eine Reihe verschiedener Faktoren zusammen. Im Kindesalter verläuft die A. lienalis stets gestreckt. Die zunehmende Schlängelung wird durch die wachsende Differenz zwischen der Länge des Gefäßes und der Distanz zwischen seinem Ursprung und dem Milzhilus hervorgerufen. Der proximale Abschnitt der Arterie ist häufiger und stärker betroffen als der distale. Die Tortuositas wird durch die zum Hauptstamm senkrechte Verlaufsrichtung der großen Äste gefördert. Weder die Schlängelung noch die Verkalkung sind als Risikoindikatoren für das vergleichsweise häufige Aneurysma der Milzarterie zu werten. Der Wandkalk ist sowohl in der Tunica media wie im Endothel lokalisiert. Hämodynamisch wirksame kalkassoziierte Gefäßstenosen fehlen. Die verkalkende Atheromatose der Milzarterie ähnelt der Mediasklerose der peripheren Arterien vom Typ Mönckeberg und wird bei Diabetikern und Dialysepatienten überdurchschnittlich häufig nachgewiesen. Die hydrohämodynamische Theorie der Arteriosklerose kann nur für die quantitativ weniger bedeutsame Verkalkung der Intima verantwortlich gemacht werden. Die Blutspeicherfunktion der Milz fördert die charakteristische altersabhängige Form- und Verlaufsveränderung der A. lienalis.

Abstract

Tortuosity of the splenic artery and calcification of the vessel wall are typical additional findings on plain abdominal x-ray. The combination of both anomalies is common in elderly persons presenting without symptoms of splenic ischemia. Its pathogenesis is thought to be multifactorial. In infancy and childhood, the splenic artery is stretched in its entire course. A growing difference between the length of the vessel and the distance between its origin and the splenic hilum gives rise to tortuosity. The artery’s proximal segment is involved more frequently and more severely than the distal one. The tortuous route of the vessel is accentuated by the direction of its major branches, which is roughly perpendicular to the main trajectory. Neither tortuosity nor calcification should be taken to be risk factors for the comparatively common splenic artery aneurysm. Calcific deposits are not confined to the media but are also detected in the intima of the vascular wall. Critical narrowings of the lumen arising on the calcium deposits are not observed. Calcifying atherosclerosis of the splenic artery is comparable to medial sclerosis of the peripheral arteries frequently noticed in diabetics and dialysis patients. Only the less important calcification of the intima may be attributed to mechanisms of the hydrohemodynamic theory of atherosclerosis. The spleen’s blood storage capacity may contribute to the characteristic age-dependent alterations of the shape and course of the splenic artery.

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  1. SELARL Association d’Imagerie Médicale, 65, rue Raymond-Poincaré, 100000, Troyes, France

    W.A. Golder

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Golder, W. Schlängelung und Verkalkung der Milzarterie im Röntgenbild. Radiologe 48, 1066–1074 (2008). https://doi.org/10.1007/s00117-008-1631-z

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