Feet First

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Wednesday, April 16, 2003
    Name That Aneurysm

    One thing I like about medicine is that you're always learning, no matter how long you've been in practice. It's no shame to admit you're unfamiliar with a disease or topic; instead, you're encouraged to read, investigate and ask questions.

    Last week a patient of mine presented to the emergency room with abdominal pain. She was worked up and sent home, but I was called by the ER doc because the radiologist had found a splenic artery aneurysm on her abdominal X ray (it was an incidental finding and not the source of her pain). As an internist, I am totally unfamiliar with splenic aneurysms; in fact, I'm not sure I had ever heard of one before. So what do we do about this?

    We check Google. Now that we have personal computers and Internet access at the office, I use Google a lot more than textbooks when I want to look something up; it's much faster. So here are the results of my search for "splenic artery aneurysm".

    Hmmm. So they do rupture. Apparently one of the higher risk scenarios is during pregnancy - at least, there are several listings regarding pregnancy and splenic artery aneurysms. My patient is postmenopausal, so that is not an issue, but one of the articles suggests that aneurysms larger in diameter than 2.0 cm are at higher risk of rupture. According to the radiologist the diameter of this one is 2.0 x 2.5 cm, so now I email our surgeon for input.

    "Get a CT scan" is the answer. The closer the aneurysm is to the branching point or origin of the splenic artery, the more likely it is that the entire spleen will need to be removed. In some cases, when it's further away, the surgeon can merely take out the dilated section of artery and anastomose (sew together) the open ends of the artery, preserving the spleen.

    So now we're waiting for the CT, which should be done sometime this week. We will then have time to have the patient meet with the surgeon and get her vaccinations before proceeding to surgery. (Since the spleen is an important part of the immune system and helps fight off bacterial infections, we like to vaccinate people against things like Strep. pneumonia and H. influenza prior to surgery if possible.)

    I also found a great article written by a man who suffered a ruptured splenic artery aneurysm - and survived. He ran thirty miles a week and was in great shape, which is probably why he lived despite several hours' delay in treatment.

    Parenthetical note: blogging will be light or none till next week as I am going to be away for Easter. Enjoy your Easter/Passover, or just enjoy spring.



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