Splenic or Renal Aneurysms
Splenic Artery
Common visceral aneurysm
Splenic artery aneurysms are the most common visceral artery aneurysms and are often discovered incidentally.
Report
- Maximum diameter and location: proximal, mid, distal, or hilar.
- True aneurysm versus pseudoaneurysm when the morphology is apparent.
- Calcification, mural thrombus, rupture/leak, adjacent hematoma, or associated portal hypertension.
- Pregnancy, childbearing-age context, transplant context, or symptoms when known from the history.
Management cues
- <2 cm and asymptomatic: usually followed, often with yearly surveillance.
- Smaller lesions may be followed at intervals of at least 1 year depending on comorbidity and life expectancy.
- >=2 cm, enlarging, symptomatic, pseudoaneurysm, rupture concern, portal hypertension, transplant, or pregnancy-related context should prompt vascular/interventional consideration.
Renal Artery
Key threshold
Many renal artery aneurysms are small and incidental; endovascular or surgical therapy is commonly considered at >=2 cm.
Report
- Maximum diameter and whether the aneurysm involves the main renal artery, segmental branch, or hilar branch.
- Calcification, thrombus, dissection, stenosis, renal infarct, renal atrophy, or pseudoaneurysm morphology.
- Laterality and relationship to renal artery bifurcation or branch vessels.
- Hypertension, hematuria, pregnancy/childbearing context, or symptoms when available.
Management cues
- <2 cm and asymptomatic: can often be followed.
- >=2 cm: consider vascular/interventional therapy.
- Escalate for symptoms, growth, rupture/leak, pseudoaneurysm, renal ischemia/infarct, or clinically relevant hypertension.
Visceral Aneurysm Pearls
General rule
Visceral artery aneurysms >=2 cm generally merit treatment consideration; pancreaticoduodenal aneurysms are treated regardless of size.
Higher concern
- Pseudoaneurysm, mycotic/infectious aneurysm, traumatic or iatrogenic aneurysm.
- Inflammatory, non-atherosclerotic, rapidly enlarging, saccular, or ruptured morphology.
- Adjacent hematoma, active bleeding, organ ischemia, or branch vessel compromise.
Follow-up habits
- Use CTA, MRA, or ultrasound depending on vessel location and visibility.
- Compare directly with prior studies and report true interval growth when measurable.
- When multiple aneurysms are present, list the largest and the highest-risk lesion.