Endovascular treatment of a splenic vein aneurysm through a transhepatic approach.

Aneurysms of the portal vein and its branches have been rarely described. Their natural history is unknown although large ones (>3 cm in diameter) have been reported to cause rupture, thrombosis, duodenal or biliary obstruction, inferior vena cava compression and/or portal hypertension. We report the case of an incidentally diagnosed 4.5 cm splenic vein aneurysm repaired by endovascular treatment through a transhepatic route. The aneurysm was successfully excluded using a covered stent (Viabahn, Gore). The transhepatic route opens the possibility of offering a minimally invasive approach to vascular lesions of the portal vein system. Splenic vein aneurysms were first reported in 1953 (1) and they are part of the extrahepatic portal vein aneurysm group (2). Their mechanism of development is not well understood. Etiology may include congenital causes (inherent weakness of the vessel wall) or acquired causes (trauma, inflammation such as pancreatitis, liver disease, or portal hypertension). However, portal aneurysms do not seem to be the result of an isolated portal hypertension since they are extremely rare even in patients with this condition (3). The demographic characteristics of extrahepatic portal vein aneurysm include a female-to-male ratio of 2:1 and the median age of 52 years (range, 5-77 years). The size of the reported aneurysms ranges from 1.9 to 8 cm. The most common location of the aneurysm is in the main portal vein trunk, the junction of the superior mesenteric vein and the splenic vein, or at the hepatic hilus; intrahepatic venous aneurysms are rare (4, 5). Here, for the first time, we report the successful endovascular treatment of a splenic vein aneurysm through transhepatic percutaneous approach using a Viabahn stent.

Inflammatory myofibroblastic tumours: a pictorial review.

OBJECTIVES: To present the most important characteristics of inflammatory myofibroblastic tumours (IMTs) arising in different locations of the body with histological correlation. METHODS: To review the symptoms and main radiological findings of IMTs. On ultrasonography (US), these tumours can appear as hypoechoic or hyperechoic masses and a variable Doppler appearance with increased vascularity. Computed tomography (CT) and magnetic resonance (MR) are the most used imaging tools in their evaluation. On contrast-enhanced CT, IMTs can appear as homogeneous or heterogeneous lesions, with variable enhancement on delayed acquisitions due to fibrosis. These findings are also present on gadolinium contrast-enhanced MR. On T1-weighted and T2-weighted sequences, IMTs usually show low signal intensity reflecting also the presence of fibrotic tissue. RESULTS: To show the main clinical symptoms and radiological features of IMTs in different locations: head and neck, lung, genitourinary, hepatic, splenic, gastrointestinal tract, mesenteric, muskuloskeletal. CONCLUSIONS: Although IMTs in some organs are not uncommon, they are not usually included in the differential diagnosis of masses. Their radiological features suggest malignant neoplasms, whereas they are not. Consequently, this is an underdiagnosed entity and only after an histological exam could a definitive diagnosis be achieved. TEACHING POINTS: • Their radiological features suggest malignant neoplasms, whereas they are not • CT and MR imaging are the most used tools in their evaluation • IMT is an underdiagnosed entity • The definitive diagnosis is only after histological exam.