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Table-II: Diagnostic accuracy of increased splenic artery pulsatility index by comparing it with histopathological changes.
Open repair, endovascular repair, and conservative management of true splenic artery aneurysms.
The splenic artery and vein are preserved in Kimura's method, and the normal blood supply of the spleen can be ensured.
(b) Coronal MIP CT images in the arterial phase showing aberrant vessel arising from the splenic artery (white arrow) and coursing obliquely from the left hypochondrium to the region of the pelvic mass (white arrowhead).
From the distal third of the splenic artery took origin two left gastroepiploic arteries (at 8 and 10 cm, respectively) which participated in the vascularization of the posterior stomach wall and the great omentum.
The distal part of the first root forms the left gastric artery (LGA), the distal part of the second root forms the splenic artery (SA), and the distal part of the third root forms the common hepatic artery (CHA).
During LND, hepatic artery variations observed were that LHA branched from the splenic artery passing through anterior side of the esophagus before entering the left liver lobe and RHA originated from SMA.
Angiography is not essential for the diagnosis but would be indicated if splenic artery pseudoaneurysm, splenic vein thrombosis, or active bleeding was suspected [2, 6].
For the patient with pancreaticopleural fistula, reported with hemoptysis 2 weeks after intercostal drainage, CT-angiogram showed multiple pseudoaneurysm involving inferior phrenic and lower intercostal arteries which was eventually managed with angioembolisation with coils (Figure 8), while another patient with infected pseudocyst developed splenic artery pseudoaneurysm in the follow-up period and required angioembolisation (Figure 9).
The CT angiogram showed a 40.1 mm dissection from the celiac origin into the hepatic artery as well as a 37.9 mm dissection from the celiac origin into the splenic artery (Figures 1 and 2).
There are three treatment options described in the literature: nonoperative management with fluid resuscitation and hemodynamic monitoring, interventional radiologic splenic artery embolization, and surgery [2, 6-8, 10].
At that time, repeat CT imaging showed decrease in the size of her mass and persistent splenic artery encasement but minimal involvement of the celiac artery and findings consistent with possible radiation-induced fibrosis (Figure 1(b)).