Management of Splenic Vascular Anomalies: A Review of 17 Pediatric Cases at a Single Institution

Splenic Vascular Anomalies (SVA) are rare splenic masses seen in the pediatric population. There is limited information regarding the management and appropriate follow-up for these patients. The aim of this study was to review our experience and create an algorithm to help guide clinical care.

A retrospective review of pediatric patients diagnosed with SVA from 2011 to 2024 was performed. Clinical history and outcomes data were summarized descriptively. A Mann-Whitney U test was performed to compare SVA diameters between surgical and nonsurgical groups.

Seventeen patients met inclusion criteria for this study. SVA was identified incidentally in 15 patients (88 %). The median maximal SVA diameter was 5.2 cm (range: 5-7 cm) for the six surgical patients and 3.6 cm (range: 1-5.7 cm) for the 11 nonsurgical patients (p = 0.009). Five patients (83 %) underwent total splenectomy, and one patient (17 %) underwent partial splenectomy. Indications for splenectomy included persistent abdominal pain, large size on imaging, and concern for splenic rupture. Preoperative imaging correlated with postoperative pathology in 4/6 (66 %) surgical patients. Among all patients, the median number of days between the first imaging study to identify the SVA and the last study monitoring the SVA was 632 days (range: 0-2337 days). The median change in SVA maximal diameter during that time was 0.05 cm (range: -1.6 - 0.9 cm).

SVA can be monitored with serial imaging and do not undergo rapid growth. Most operative interventions are performed based on SVA size (>5 cm) and rarely on symptoms.