Celiac artery aneurysm: Ultrasonic diagnosis

Celiac artery aneurysms represent an important, although unusual, form of splanchnic vascular disease. Since rupture is a significant complication , surgical intervention is recommended following diagnosis.' Inasmuch as most celiac aneu-rysms are asymptomatic or present with vague epigastric pain prior to rupture, preoperative diagnosis is infrequent and is usually made incidentally during unrelated surgery or angiog-raphy. To our knowledge, a case in which routine abdominal sonography provided the correct diagnosis initially has not been reported. A 68-yr-old white woman presented to her primary care physician with a 15-month history of occasional nausea and vague abdominal discomfort , without associated pain, weight loss, or vomiting. Physical examination was normal, without palpable mass or tenderness. An ultrasound examination performed at another institution reportedly showed a pancreatic pseudocyst. She was subsequently referred to the University of Michi-gan Medical Center for further evaluation, where an upper GI series demonstrated a possible ret-rogastric mass. Because of the clinical suspicion of pancreatic disease, sonographic evaluation of the pancreas was requested and revealed a 2.5-cm cystic mass arising from the proximal celiac trunk, diagnostic of a celiac artery aneurysm (Fig 1A and B). The body of the pancreas was well visualized and normal (Fig 1A). Subsequent angio-graphic confirmation was obtained preopera-tively (Fig 1C and D), and surgical resection was performed with primary end-to-end anastomosis of the common hepatic artery to the proximal splenic artery. No associated inflammatory tissue , pancreatic abnormality, or blood clot suggesting prior rupture was found. The patient experienced an uneventful postoperative course and was asymptomatic three months following aneu-rysmectomy. DISCUSSION Celiac artery aneurysms account for 4% of splanchnic aneurysmal disease, and a total of 81 cases has been reported in the world literature .2 The causes and clinical importance of ce-liac artery aneurysms have changed markedly in recent years. Most of the 58 aneurysms reported prior to 1950 were luetic in origin, and catastrophic rupture and death were exceedingly common. Although most of these patients were symptomatic, an antemortern diagnosis was established only once in this group of patients. Since 1950, 43 celiac artery aneurysms have been reported. In contrast to earlier reports, arteriosclerotic changes have been noted in most of these lesions. The most common clinical manifestation has been epigastric, abdominal, and back discomfort. Hemorrhage as a complication has been distinctly unusual in recent cases. Recognition of celiac artery aneurysms during the past 30 yr has occurred with increasing frequency with greater …