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Child undergoing abdominal imaging.

Our appreciation is extended to Dr. Stephen Kim,
Indiana University Department of Radiology,
for contributing this case.

History:  Child undergoing abdominal imaging.
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Which choice most likely characterizes the patient's clinical history?

Trauma.Lymphoma.Hemolytic anemia.Sepsis.Cystic fibrosis.
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Child undergoing abdominal imaging.



Which of these choices is most consistent with the central enhancing focus on the image below (also shown on prior page)?

May represent a pseudoaneurysm.May represent some active extravasation.Either A or B.Neither A or B.Image
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Child undergoing abdominal imaging.

Here are some ultrasound images of the same patient. Click to enlarge.

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Which choice is most compatible with the ultrasound findings?

Splenic cyst.Pseudoaneurysm.Traumatic AVM.Granuloma.Splenic hemangioma.
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Child undergoing abdominal imaging.

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Findings:  The CT abdomen study demonstrates a grade 4 splenic laceration and focal outpouching of an intrasplenic artery. Sonographic images of the spleen demonstrate a subcentimeter hypo echoic focus demonstrating mixed vascular flow in a “yin yang” appearance.

Diagnosis:  Splenic pseudoaneurysm
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Child undergoing abdominal imaging.


Key Points:  

  • Pseudoaneurysm is defined as outpouching of a blood vessel, involving a defect in the 2 innermost layers (tunica intima and media) with continuity of the outermost layer (adventitia)
  • Grayscale ultrasound:
    • Usually hypo echoic or anechoic structure
    • Slow flow may occasionally be seen
    • Neck connects pseudoaneurysm to artery
    • String of aneurysms with multiple lumens is common
    • Thrombus may be seen in the lumen
  • Pulsed Doppler:
    • Characteristic "to and fro" flow is typically present in the neck of the aneurysm
    • Turbulent high velocity flow may be present if the neck is narrowed
  • Color Doppler:
    • Characteristic "yin-yang" sign
    • Swirling flow seen as different color signals within lesion
    • Lumen may not be fully filled with color due to partial thrombosis
    • Flow can sometimes be detected in needle tract without an associated lumen
  • CT findings
    • Arterial enhancement of lumen of pseudoaneurysm
    • Contrast extravasation may be present if there is rupture of the pseudoaneurysm
    • Fresh hematoma around pseudoaneurysm may be slightly hyper dense

References:

  1. Statdx.com. 2011
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Child undergoing abdominal imaging.


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