P132 | Role of ultrasound and contrast enhanced ultrasound performed by Internal Medicine physicians in the management of splenic artery aneurysm treatment and complications

E. Sagrini, D. Rosica, V. Benintende, A. Del Vecchio, M. Domenicali | UOC Medicina 1 ad Indirizzo Fragilità e Invecchiamento, Ospedale S. Maria delle Croci, Ravenna, AUSL Romagna, Italy

Case report: A 65-year-old man presented to Medicine ward for bronchial exacerbation and worsening chronic kidney disease. Abdominal ultrasound (US) was performed with random detection of proximal splenic artery aneurysm (diameter 25 mm). Angio-CT confirmed splenic aneurysm (diameter 27 mm), without signs of rupture, spleen was normal. Patient was admitted to surgery ward for splenic artery embolization; open surgery excluded due comorbidities. Two days after embolization patient was referred to our Internal Medicine US service due to abdominal pain. Spleen showed inhomogeneous echopattern. Contrast-enhanced US (CEUS) revealed an ischemic area of the splenic upper pole/hilum (about 45% of spleen area). Two days after patient developed fever, peritonism in the left abdominal quadrant and was put on antibiotics. In the suspicion of splenic abscess surgeon listed patient for potential splenectomy. Due to comorbidities, primary follow up with CEUS was decided on multidisciplinary discussion. Few days later, bedside CEUS reported a reduction in the ischemia (about 35% of splenic area), partial revascularization of hilum, no abscess. Conservative approach was kept, patient improved, discharged day 12th. At two months followup patient was well; at CEUS complete reperfusion of the spleen through collaterals.
Conclusions: US played a pivotal role in multidisciplinary evaluation, since followup by CEUS allowed timely bedside diagnosis of splenic infarction and accurately monitored size of infarcted area, allowing conservative management. Ultrasound is an essential tool in the hands of internists.