Date:
Patient:
Reason for Visit:
Initial evaluation for suspected splenic artery aneurysm (SAA)
Follow-up for diagnosed SAA
Assessment of aneurysm size, stability, and management plan
Evaluation of symptoms or potential complications
History:
Presenting Illness: (For initial evaluation)
Presence or absence of abdominal pain (may be dull, aching, or sharp, often in the left upper quadrant)
Abdominal fullness or distention
Nausea, vomiting, or other gastrointestinal symptoms (less common)
Past episodes of pancreatitis (may be associated with SAA)
Risk factors for atherosclerosis (e.g., hypertension, hyperlipidemia, smoking)
Past Medical History (PMH):
Comorbid conditions that may increase risk of SAA (e.g., connective tissue diseases, vasculitis)
Previous abdominal surgeries (may increase risk of rupture)
Social History:
Smoking history (major risk factor)
Physical Exam:
General: Assess vital signs (temperature, blood pressure) and overall health.
Abdominal: Evaluate for abdominal tenderness, pulsatile mass in the left upper quadrant (uncommon), or signs of internal bleeding (hypotension, pallor).
Diagnostic Tests (may be ordered depending on clinical suspicion):
Imaging Studies:
Abdominal ultrasound – initial imaging modality to identify an aneurysm and measure its size.
CT angiography with contrast – most definitive imaging study for diagnosing SAA, providing details on size, location, and involvement of surrounding structures.
Magnetic resonance angiography (MRA) (alternative to CT angiography) – may be used in some cases with concerns about contrast exposure.
Assessment:
Clinical suspicion of SAA: Based on history and physical exam findings, particularly presence of risk factors.
Confirmation of SAA: Requires imaging studies like CT angiography or MRA.
Aneurysm size and location: Critical for determining management approach.
Risk of rupture: Depends on aneurysm size, growth rate, and patient-specific factors.
Plan:
Treatment approach depends on several factors:
Aneurysm size (< or > 3 cm)
Presence of symptoms
Risk of rupture (considered high for aneurysms > 3 cm)
Patient’s overall health and surgical candidacy
Management options:
Observation: For small aneurysms (< 3 cm) with no symptoms, regular imaging follow-up is recommended to monitor for growth.
Endovascular embolization: Minimally invasive procedure to block blood flow into the aneurysm using coils or stents. Preferred approach for many patients.
Laparoscopic or open surgical repair: May be necessary for large aneurysms (> 3 cm), symptomatic aneurysms, or those with high risk of rupture. Surgery involves resecting the aneurysm and reconstructing the splenic artery.
Medical management: Regardless of the chosen intervention, optimizing medical management of risk factors like hypertension and hyperlipidemia is crucial.
Follow-up:
Regular follow-up appointments with imaging studies (ultrasound or CT angiography) to monitor aneurysm size and stability.
Earlier intervention may be necessary if the aneurysm shows rapid growth or becomes symptomatic.
Patient education: Provide information about SAA, its causes, risk factors, and treatment options.
Discuss the importance of regular follow-up and potential complications of SAA rupture.
Encourage lifestyle modifications to manage risk factors and improve overall health.
Address any concerns or questions the patient may have.
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and treatment of splenic artery aneurysm.