A case of idiopathic portal hypertension accompanied by calcified splenic arterial aneurysm

Abstract

A case of idiopathic portal hypertension (IPH) accompanied by splenic arterial aneurysm is reported. A 58 year-old female was admitted for pancytopenia. Abdominal X-rays showed a calcified shadow in the left upper abdomen. Celiac angiography showed splenomegaly, a dilated and tortuous splenic artery and a calcified splenic arterial aneurysm in the splenic hilus. Changes in the intra-hepatic arterial branches were not remarkable. Portography revealed a huge splenorenal shunt.
Blood flow volumes in the portal system, obtained using an ultrasonic Doppler system were: portal vein; 1301ml/min, splenic vein proximal to the spleno-renal shunt; 710ml/min. Portal venous pressure was 24 mmHg. Occlusion of the splenic artery by a balloon catheter resulted in hepatofugal splenic venous flow at 456ml/min. Portal venous pressure decreased to 19 mmHg. Liver biopsy was normal.
The splenic arterial aneurysm was thought to result from accelerated blood circulation, due to IPH, being further accelerated by the exisistence of the outflow pathway -the spleno-renal shunt- with its low vascular resistance.