Splenic artery dissection: a case report and review of the literature

Spontaneous arterial dissection may occur in a dramatic fashion and is often fatal if treatment is not instituted promptly. Diagnosis may be particularly difficult when cases of arterial dissection appear in unusual locations. We report a rare case of atraumatic dissection of the splenic artery that occurred in a 66-year-old male patient, who was admitted with acute severe epigastric and substernal pain, which worsened on inspiration. On admission, his physical examination was unremarkable, and he was hemodynamically stable. After excluding cardiopulmonary catastrophes and aortic dissection as a cause, a left retroperitoneal mass was found on arteriography to be a contained rupture of a splenic artery dissection. The patient underwent urgent resection of the splenic artery with preservation of the spleen. Splenic artery dissection is a rare condition. Only 11 cases have been previously published in the literature, and all of these cases were diagnosed after death. Successful management depends on consideration of the diagnosis, especially when other more common disease processes have been excluded.