Splenic Vein Aneurysm: A Rare and Incidental Finding

Splenic vein aneurysms are a rare and incidental occurrence. Most patients are asymptomatic. Etiologies can include portal hypertension or congenital weakness in the vessel wall. Diagnosis can be made via duplex ultrasonography or computed tomography scanning. A 68-year-old female presented to our Emergency Department with a 3 day history of severe lower abdominal pain and constipation. She had been seen one week prior for lower back pain and was given a prescription for Oxycodone. On admission her blood pressure was 135/78 mmHg with a heart rate of 85. Abdominal exam revealed a nondistended abdomen with mild tenderness to palpation in the left lower quadrant. Labs were significant for a leukocytosis of 16,500 and a creatinine of 1.69 (increased from baseline of 0.6 ). A CT Abdomen Pelvis without contrast was performed which showed “extensive jejunal diverticulitis and an indeterminate 2.5 cm mass like density in the pancreatic tail”. CA 19-9 was normal. The patient underwent an MRI Abdomen which showed a hyper-vascular lesion in the pancreatic tail. This was followed by a labeled RBC Scan which showed the pancreatic tail lesion to have increased blood volume. The patient received I/V antibiotics while in hospital for her jejunal diverticulitis. She was discharged home with oral antibiotics to complete a total course of 2 weeks. EUS was done as an outpatient for further characterization which showed a dilation in the splenic vein. To confirm findings on EUS, patient underwent CT angiogram of the abdomen which re-demonstrated a splenic venous varicosity. The patient's case was discussed with Vascular Surgery who recommended repeating serial CT Angiogram to assess for enlargement which would necessitate intervention. Splenic vein aneurysms are uncommon. Complications of splenic vein aneurysms can include compression of adjacent structures, thrombosis or rupture. Management of splenic vein aneurysms can be conservative with serial non-invasive imaging versus plication and aneurysm excision. Because the incidence of these aneurysms is low, exact treatment is not well defined and each case needs to be individually evaluated. Our patient remains asymptomatic and continues to be followed.2926_A Figure 1. Computed tomography scan demonstrating a 2.5 cm density in the pancreatic tail2926_B Figure 2. Endoscopic Ultrasound demonstrating a 15 x 21 mm dilation in the splenic vein.2926_C Figure 3. CT Angiogram of the abdomen showing splenic veins showing an area of enlargement measuring 2.9 cm.