Medical Rehabilitation Centre, Moscow, Russia.
Endosc Ultrasound. 2014 Apr;3(Suppl 1):S8-9.
The etiology of true and false splenic artery aneurysm is different, but the differential X-ray contrast diagnosis could be difficult. Purpose - to detect endoscopic ultrasonography (EUS) diagnostic capability for false and true splenic artery aneurysm by considering two clinical cases: With suspected stomach and pancreatic lesions.
Patient, female, 50-year-old with suspected stomach lesion, complicated by gastric bleeding. Endoscopy - acute gastric ulcer. X-ray - submucosal gastric tumor. The patient was sent to the EUS with fine-needle aspiration.
Patient, male, 73-year-old with suspected pancreatic neoplasm. Ultrasound - pancreatic cysts. Computed tomography (CT) - neoplasm of the pancreas body. Celiacography - splenic artery aneurysm. The patient was sent to the EUS to clarify the diagnosis.
First patient EUS - anechoic rounded lesion with thick wall close to the stomach. Stomach wall layers were not differentiated above the lesion. Doppler - turbulent blood flow. EUS excluded submucosal lesion and proved the presence of aneurysm. CT confirmed the aneurysm. Post-operative histology - splenic artery pseudoaneurysm, destruction of the stomach wall and pancreatic parenchyma. Second patient EUS - ovoid solid-cystic lesion with thin hyperechoic "capsule." Doppler in cystic part - arterial blood flow. EUS suspected saccular splenic artery aneurysm with the neck and the residual lumen. Post-operative histology - true splenic artery aneurysm with thrombotic masses near the wall, pancreatic parenchyma was intact.
EUS can reliably differentiate splenic artery aneurysm from gastric submucosal lesion and differentiate true and false aneurysm with high probability.
真性和假性脾动脉瘤的病因不同，但 X 射线对比诊断可能存在困难。目的 - 通过考虑两个临床病例：怀疑胃和胰腺病变，来检测内镜超声（EUS）对假性和真性脾动脉瘤的诊断能力。
病例 1：患者，女性，50 岁，有胃病变疑似，伴有胃出血。内镜检查 - 急性胃溃疡。X 射线 - 黏膜下胃肿瘤。患者因细针抽吸术被送往 EUS。
病例 2：患者，男性，73 岁，有胰腺肿瘤疑似。超声 - 胰腺囊肿。计算机断层扫描（CT） - 胰体部肿瘤。腹腔动脉造影 - 脾动脉瘤。患者因明确诊断而被送往 EUS。
第一个患者的 EUS - 靠近胃部的厚壁无回声圆形病变。病变上方胃壁层未分化。多普勒 - 血流紊乱。EUS 排除黏膜下病变并证实了动脉瘤的存在。CT 证实了动脉瘤的存在。术后组织学 - 脾假性动脉瘤，胃壁和胰腺实质破坏。第二个患者的 EUS - 椭圆形实性囊性病变，有薄的高回声“包膜”。囊性部分的多普勒 - 动脉血流。EUS 怀疑有颈和残余管腔的囊状脾动脉瘤。术后组织学 - 真性脾动脉瘤，靠近壁的血栓块，胰腺实质完整。
EUS 能够可靠地区分脾动脉瘤与胃黏膜下病变，并高度可能区分真性和假性动脉瘤。
