773 - A Life-Saving Clue: The Pulmonary Embolism that Exposed an Impending Celiac Aneurysm Rupture

Friday, February 23, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

KK

Karthik B. Kamath, DO

PM&R Resident
Nassau University Medical Center
Coram, New York, United States

Co-Author(s)

KS

Kanwardeep Singh, MD

Resident Physician
Nassau University Medical Center
East Meadow, New York, United States
PA

Peter Atallah, DO

PM&R Resident Physician
Nassau University Medical Center
East Meadow, New York, United States
JE

Jenzel Espares, DO

PM&R Resident Physician
Nassau University Medical Center
Seaford, New York, United States
AS

Ajendra S. Sohal, M.D.

PM&R Attending Physician
Nassau University Medical Center
East Meadow, New York, United States

Case Diagnosis: Celiac Artery Aneurysm

Case Description: A male patient, aged 55, with a medical history notable for hypertension, a long history of smoking, and having undergone recent anterior cervical discectomy and fusion, as well as right tibia intramedullary nailing, was admitted to acute rehabilitation. The patient was on daily Lovenox for DVT prophylaxis. The patient was functionally progressing but began to have non-reproducible left-sided mid-axillary pain when taking a deep breath with borderline tachycardia. Given the pleuritic nature, lower extremity dopplers and CT angiogram were ordered. The patient was found to have segmental and subsegmental right upper lobe pulmonary embolism. However, incidental aneurysmal dilatation of the celiac artery was noted. The patient was transferred to Medicine for further workup and management. Abdominal CT angiogram revealed 1.1 cm dilation with minimal surrounding fat haziness. Given the possibility of a mycotic aneurysm, vascular surgery recommended transfer for immediate open and endovascular repair of the celiac aneurysm.

Discussions: Visceral artery aneurysms including celiac are sporadic and found in 0.1% of the general population. Most are asymptomatic and found incidentally on imaging when looking for other pathology as in our patient. Etiology includes infection and atherosclerosis for which smoking is a significant risk factor. Complications include acute arterial insufficiency, distal embolization, and rupture. A ruptured celiac artery aneurysm carries a mortality of up to 70%.

Conclusions: Although rare, there needs to be a high degree of suspicion for visceral artery aneurysms in male patients with a significant smoking history. Early detection of aneurysms results in a better prognosis as complications can cause a significant increase in morbidity and mortality. Given the devastating consequences of possible rupture, intervention was chosen for our patient. More research on cost-effective screening methods needs to be performed to catch these aneurysms, over just plain luck.