Berry splenic artery aneurysm rupture in association with segmental arterial mediolysis and portal hypertension

A rare case of berry splenic artery aneurysm (SAA) rupture associated with segmental arterial mediolysis (SAM) and portal hypertension is reported. A 66‐year‐old woman, diagnosed as having liver cirrhosis and portal hypertension 6 years earlier, suddenly developed a lancinating pain in the upper abd...

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Bibliographic Details
Published in:Pathology international 2005-05, Vol.55 (5), p.290-295
Main Authors: Imai, Miwa Akasofu, Kawahara, Ei, Katsuda, Shogo, Yamashita, Tatsuya
Format: Article
Language:English
Subjects:
Aged
Aneurysm, Ruptured - etiology
Aneurysm, Ruptured - pathology
Arteritis - complications
Fatal Outcome
Female
fibromuscular dysplasia
Hemorrhage - etiology
Humans
Hypertension, Portal - complications
liver cirrhosis
portal hypertension
rupture
segmental arterial mediolysis
Splenic Artery
splenic artery aneurysm
sudden death
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Summary:A rare case of berry splenic artery aneurysm (SAA) rupture associated with segmental arterial mediolysis (SAM) and portal hypertension is reported. A 66‐year‐old woman, diagnosed as having liver cirrhosis and portal hypertension 6 years earlier, suddenly developed a lancinating pain in the upper abdomen and lost consciousness. She recovered consciousness while being transferred to hospital by ambulance. During the investigations, her level of consciousness suddenly deteriorated. Ultrasonography showed a massive intraperitoneal hemorrhage, and she died 5½ h after admission. On gross examination at autopsy it was not possible to find the rupture point of the vessel because the pancreas was embedded in a massive hematoma. However, careful dissection of the pancreatic tail after fixation revealed a berry aneurysm measuring 0.8 cm in diameter in a branch adjacent to the bifurcation in the distal third of the main splenic artery. Microscopic examination detected a rupture of the aneurysm. The histology of the arterial wall proximal to the aneurysm showed typical SAM. In general, berry SAA caused by SAM is rare and unlikely to rupture. The SAA in the present case likely occurred and ruptured due to the combination of SAM and portal hypertension.
ISSN:1320-5463
1440-1827
DOI:10.1111/j.1440-1827.2005.01827.x