An 80-year-old female with past medical history of hypertension, hyperlipidemia, diabetes mellitus type 2, and history of remote smoking presented to her primary care doctor for evaluation of ten days history of cough. She did not report any chest pain, shortness of breath, or fever. Her physical examination was unremarkable. two view chest X-ray revealed a clear lung parenchyma with normal heart size, calcific thoracic aorta, and an interesting incidental finding of possible splenic artery aneurysm (Figure 1 and Figure 2). The patient was asymptomatic; she denied left upper quadrant pain, nausea, or vomiting. Computed tomography (CT) scan of the abdomen demonstrated significant atherosclerotic changes of the aorta without aneurysmal dilation, normal renal and mesenteric arteries, a partially calcified splenic artery aneurysm measuring maximum diameter of 2.0 cm, and there is also an area of the splenic artery ectasia where the vessel diameter reaches 0.8 cm (Figure 3 and Figure 4). After a detailed discussion with vascular surgery and interventional cardiology; the multidisciplinary team decided to monitor the patient every six months. In event of aneurysmal enlargement more than 2.5 cm, the patient will be a candidate for elective splenic artery aneurysm procedure.

Splenic artery aneurysm is common visceral aneurysm; it is the third most common aneurysm after abdominal aortic and iliac aneurysms. Most of the time patients are asymptomatic, found incidentally during routine investigations. It can cause left upper quadrant abdominal pain, nausea, and vomiting. In rare cases, it could rupture and leads to shock [1].

Risk factors include hypertension, atherosclerosis, and iatrogenic during abdominal surgeries. There is no consensus when to operate, but it has been suggested that pregnant women, symptomatic patients should undergo repair procedure [2]. It is often difficult to correctly diagnose splenic artery aneurysm in asymptomatic patients who present with only chest X-ray or abdominal ultrasound; differential diagnosis included pancreatic cyst, pancreatic tumor, calcified left adrenal hematoma. Computed tomography and or magnetic resonance angiography can easily recognize the splenic artery aneurysm [3] . There is no specific guidelines on how to treat asymptomatic splenic artery aneurysm, though it is widely accepted to evaluate any aneurysm size more than 2.0 cm. for possible intervention. Treatment modality can be either endovascular or surgical; percutaneous intervention with either coil embolization or covered stent have been associated with a better short-term results compared to open repair, while open repair has less long-term complications including less re-exploratory procedures. The main indications for either types of the intervention are symptomatic patients, pregnancy, and pseudoaneurysm. Splenic artery anatomy is the main factor to decide which procedural approach the doctors should take [4][5]. Timing for repair in asymptomatic patients is not standardized, but asymptomatic aneurysm of size 1–2 cm can be monitored safely every six months with an imaging method [6] .

Splenic artery aneurysm is the third common abdominal aneurysm yet it is still rare, we present this nice chest X-ray. Splenic artery aneurysm is not just a radiographic diagnosis alone; it requires confirmation with other either computed tomography angiography and/or Doppler ultrasound. In this case, we will do a follow-up computed tomography scan in six months.

Keywords:Aneurysm, Asymptomatic, Imaging, Spleen, Splenic artery

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