Routine Ultrasound Can Catch Hidden Visceral Artery Aneurysms

For detecting unruptured visceral artery aneurysms larger than two centimeters in diameter, US is as effective as CT—and it should be part of a routine abdominal exam, researchers say.

“People are not going to the hospital with visceral artery aneurysms because they are mostly asymptomatic,” said Monika Zbroja-Putowska, MD, from the Medical University of Lublin in Poland, who presented research during the Thursday vascular imaging scientific session. “Though they can be life-threatening if ruptured, these aneurysms are often found incidentally.”

Review of US Images Found Aneurysms In Non-Symptomatic Patients

Dr. Zbroja-Putowska’s team reviewed US images from routine fasting exams in 12,540 patients aged 16 to 85. They applied B-mode morphological assessment and an additional hemodynamic evaluation with color and spectral Doppler to each case.

The team found aneurysms in 94 patients, none of whom presented with characteristic symptoms; 36 of them had reported non-specific abdominal pain. Fifty-two cases were of splenic artery aneurysms, while 16 were hepatic, 14 in the celiac trunk, four gastro-duodenal, six superior mesenteric and two inferior mesenteric. These were verified by CT. In 62 cases, the diameter of the aneurysm exceeded 2 centimeters.

Thirty-six of the patients were referred to emergency admissions for successful embolization.

One case particularly illustrated the value of US in a routine exam: That of a pregnant woman who had shown no specific symptoms. US revealed a 20-millimeter aneurysm in her splenic artery.

“When it comes to mortality in the rupture of visceral arteries, it’s normally up to 25%,” Dr. Zbroja-Putowska said. “But in pregnant women, we see up to an 80% mortality. That’s a very big difference, and it’s very important to remember. This patient was successfully embolized thanks to a routine ultrasound.”

Dr. Zbroja-Putowska believes that US should be part of a yearly routine abdominal exam, especially as patients age.

Limitations In Using US

The diagnostic effectiveness of US has limitations. It’s less precise when aneurysms are smaller than 2 millimeters. In these cases, and in cases of vessel wall rupture where free intraperitoneal blood can obscure the vascular morphology, CT is a more effective tool. CT may also be a better choice in cases where a patient’s critical condition limits effective cooperation during an exam. However, as an accessible, cost-effective exam that doesn’t use ionizing radiation, US is a valuable alternative for incidentally spotting visceral artery aneurysms in patients who have no symptoms.

Dr. Zbroja-Putowska offered advice for incorporating US into an abdominal examination routine. “We should use the appropriate imaging techniques, such as B-flow and Doppler modalities—color, pulsed and power Doppler—for more precise evaluation of vessel morphology and hemodynamic flow parameters.”

She also emphasized reminding the patient to fast before the exam. “Then we can avoid the instances where the patient says, ‘Oh, I just had a small sandwich,’ and then we cannot see anything.”

“When it comes to bigger arterial aneurysms, which can be life-threatening, it’s really important to have them properly measured to find out whether they’re bigger or not,” she added.

Access the presentation, “Aneurysm Echo – The Role of Ultrasonography in the Diagnosis of Visceral Artery Aneurysms,” (R1-SSVA04) on demand at RSNA.org/MeetingCentral.