Abdominal CT scan was deferred due to the patient’s pregnant state

and her apparent clinical improvement. However, abdominal pain recurred after about a week into the admission. An ultrasound was done to determine if gallstones were the cause of the pancreatitis and recurrent pain, but none were seen. Instead, the ultrasound showed splenomegaly and splenic varices, a normal-sized liver with smooth contour and homogeneous parenchymal echopattern, and a normal-sized portal vein. Left sided portal hypertension was considered which, in the setting of pancreatitis, was possibly due to splenic vein thrombosis. A Doppler study of the splenic vein was done showing sluggish but hepatopetal blood flow in the visualized areas of the splenic vein. Some segments of the vein were not adequately assessed due to overlying bowel gas. It was eventually decided that an endoscopic ultrasound 5-Fluoracil was necessary

see more to adequately assess the splenic vein, pancreas as well as the liver. On EUS, a thin-walled outpouching from the wall of the splenic artery measuring approximately 5 cm in diameter with flow on Doppler study, consistent with a pseudoaneurysm, was seen (Figure 1). No thrombosis was seen in the splenic vein. The visible portions of the pancreas and liver appeared normal. Given these new findings, preparations were begun for possible surgical management of the pseudoaneurysm. Patient was kept admitted and under close monitoring while the fetus was allowed to mature. At 34 weeks age of gestation, the baby was delivered by cesarean section. An abdominal CT scan was subsequently done confirming the presence of a splenic artery pseudoaneurysm measuring 9 cm in diameter with a thrombus noted within (Figure 2).

The pseudoaneurysm was compressing the adjacent splenic vein which explained the splenomegaly, splenic varices and the presence of a splenorenal shunt. Scattered calcifications were also noted throughout the pancreatic parenchyma suggestive of chronic pancreatitis. The patient finally underwent aneurysmectomy and splenectomy and was subsequently discharged after an unremarkable postop course. The patient has followed up at the outpatient clinic and has remained pain-free since her discharge. Results: Splenic artery pseudoaneurysms Arachidonate 15-lipoxygenase are rare. In a study done in the Mayo Clinic, cases referred for evaluation of visceral artery aneurysms over an 18-year period were retrospectively reviewed. In this time frame, only ten cases were identified as splenic artery pseudoaneurysms. The most common symptoms associated with this condition were bleeding and abdominal or flank pain. While true visceral artery aneurysms are usually associated with arteriosclerosis, pseudoaneurysms, including those arising from the splenic artery, usually develop secondary to previous inflammation or trauma.