Splenic artery aneurysm: value of color Doppler and the limitation of gray-scale ultrasonography

Background: To reevaluate the advantages and limitations of gray-scale and color Doppler sonography in the diagnosis of splenic artery (Sp-A) aneurysm. Methods: We reviewed the gray-scale and color Doppler sonogram's of five cases with Sp-A aneurysm (four patients with portal hypertension and one patient without portal hypertension). Color Doppler sonography was performed in all five:patients, and power Doppler sonography was performed in three. Results: Gray-scale. sonography failed to detect the aneurysm in four of five cases because of a surrounding splenorenal (Sp-R) shunt in three patients and marked calcification of the aneurysmal wall in one-patient. Pulsed Doppler sonography showed a slightly turbulent pulsatile-flow :along the aneurysmal wall, which immediately led to the diagnosis:in four cases, including the three cases with Sp-R shunt, In one case, color Doppler sonography failed to detect the aneurysm because of a markedly calcified aneurysmal wall, although power Doppler sonography could visualize the aneurysm. Conclusions: Gray-scale sonography is not a useful diagnostic tool for Sp-A aneurysm. Clinicians should use color Doppler sonography in the evaluation of the splenic hilus in patients with Sp-R shunt to find a small Sp-A aneurysm. The addition of power Doppler sonography is helpful in visualizing calcified Sp-A aneurysms