Presentation
Sudden onset left subcostal pain with vomiting after physical exercise.
Patient Data
Variant anatomy with aortic origin of the splenic and left gastric arteries.
The splenic artery is dissected from the ostium in its entire length with associated intramural hematoma. There is a 7mm false aneurysm in the proximal splenic artery and a further 4mm false aneurysm in the mid segment. Extensive acute splenic infarction as demonstrated on the portal venous phase study.
Case Discussion
This is an interesting case of a 35 year old well adult male who developed sudden onset left upper quadrant abdominal pain after performing plyometric type exercises. His pain was described as severe and radiated to his back. He had no risk factors for vascular or thromboembolic disease.
CT angiogram revealed an extensive splenic artery dissection and splenic infarction as described in the imaging findings. A vasculitic screen was performed, which was negative.
The patient was discussed at a multidisciplinary meeting where the possible diagnosis of fibromuscular dysplasia was raised. In particular, the rare variant of segmental arterial mediolysis (SAM). This would be in keeping with the lack of local inflammatory signs around the splenic artery on imaging (i.e. non-inflammatory arteriopathy) and lack of risk factors for atherosclerotic disease.
The patient was treated non-operatively with strict blood pressure control. He had serial monitoring of his splenic aneurysms and there is ongoing discussion as to whether he will benefit from endovascular or open surgical treatment options.
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