I just had a foreign body sensation in my throat, so I went to the otolaryngology department for an esophageal CT scan. The report said that there was no abnormality in the esophagus. Who would have expected that there was a silent "time bomb" hidden in the abdominal cavity.
Recently, the First Affiliated Hospital of Zhejiang University School of Medicine (hereinafter referred to as "Zhejiang University First Hospital") received a 32-year-old woman of childbearing age. She had no abdominal pain, bloating or other abdominal discomfort. She went to the hospital because of a foreign body sensation in the throat and underwent a plain esophageal CT examination. No vascular abnormalities were found in routine film reading, but the in-hospital AI imaging model iVAA identified suspicious lesions, suggesting the possibility of a splenic artery aneurysm. The size of the lesion was approximately 22.6 mm × 16.0 mm.
After receiving the early warning, the team immediately reviewed the images, determined it to be a high-risk case, and notified the patient by phone to return to the hospital for review. After the National Day, the patient underwent CT angiography (CTA) of the abdominal aorta and was diagnosed with a splenic aneurysm, which met the indications for surgery.
"Many people panic when they see the word 'tumor' in the report. Some people think that everything will be fine if it doesn't hurt. Some young people think that this disease has nothing to do with them." Zhang Hongkun, director of the vascular surgery department at the First Hospital of Zhejiang University, said in an interview with China News Service that in outpatient clinics, patients often have the following three misunderstandings about visceral aneurysms.
Myth 1: An aneurysm is a tumor?
When many patients see the word "tumor", their first reaction is cancer and they worry about chemotherapy. "Aneurysms are not malignant tumors." Zhang Hongkun explained that tumors are tumors caused by abnormal proliferation of cells; aneurysms are caused by damage to the blood vessel wall, reduced elasticity, and local bulging outwards under the impact of blood flow, just like a bulge in an aging water pipe. Aneurysms do not contain cancer cells and will not metastasize, but once they rupture, they may cause massive abdominal bleeding and be life-threatening.
Misunderstanding 2: If there is no pain, does it mean it is safe?
Visceral aneurysms can occur in the splenic artery, hepatic artery, renal artery, celiac trunk, superior mesenteric artery and other locations. When these blood vessels are deep and the tumor is small, the patient may not have obvious symptoms such as pain or abdominal distension, and there may be no warning before rupture, so they are easily ignored.
Myth 3: Visceral aneurysm is a disease of the elderly and young people will not get it?
"Clinically, patients in their thirties and forties are not uncommon. Being young does not mean that blood vessels are safe." Zhang Hongkun reminded that young people should also pay attention to related risk factors, including long-term poorly controlled hypertension, smoking, staying up late for a long time, as well as congenital connective tissue abnormalities, congenital weakness of blood vessel walls, repeated pancreatitis and abdominal trauma. Some young and middle-aged people have high blood pressure but do not monitor and intervene in time. Long-term elevated blood pressure may damage blood vessels and gradually form lesions.
The diagnosis cannot be confirmed by plain CT scan! Vascular assessment is particular
Ordinary plain CT mainly observes organs and soft tissues, and it is difficult to see the entire lumen of blood vessels. The lesions are easily blocked by the intestines and organs, and small aneurysms are easily missed. Contrast-enhanced CT angiography (CTA) is the gold standard for diagnosing visceral aneurysms. The contrast agent "lights up" the blood vessels so that the size, shape and relationship between the tumor and branch blood vessels can be clearly seen.
Whether intervention is needed cannot be determined solely by the size of the aneurysm. In addition to the diameter, the doctor will also evaluate whether the tumor is regular in shape, cystic, and its growth rate, and make a comprehensive judgment based on the patient's blood pressure, pregnancy preparation plan, and the presence of dissection. Even if the tumor size has not yet reached the intervention threshold, intervention may be required if the tumor is abnormal in shape and progresses rapidly.
AI-assisted early warning, diagnosis and treatment still require doctor’s judgment
In the future, when patients undergo ordinary plain CT examinations, AI is expected to simultaneously prompt suspicious visceral artery lesions and help doctors detect problems earlier.
In the past, some patients with visceral aneurysms were not diagnosed until they ruptured and required emergency room visits. With the help of AI tools, it is expected to detect suspicious lesions during the physical examination and provide auxiliary screening for primary hospitals and physical examination centers.
Zhang Hongkun emphasized that AI provides clues to suspicious lesions and cannot directly make a diagnosis. After receiving the AI warning, the vascular surgeon needs to determine whether there is indeed a lesion, evaluate whether further CTA examination is needed, and then comprehensively assess the risk of rupture based on the patient's age, underlying diseases, family planning, etc. Whether intervention is needed, whether minimally invasive or open surgery is chosen, the final treatment plan must be decided by the clinician.
Who should consult a doctor to assess whether further examination of abdominal blood vessels is needed?
• People who have long-term hypertension and poor blood pressure control, especially young and middle-aged patients
• People who smoke and have high blood lipids
• People with a history of pancreatitis or abdominal trauma
• Those with a family history of connective tissue disease or congenital vascular dysplasia
• Women of childbearing age can consult their doctor to learn about the risks associated with splenic aneurysm
• Ordinary CT shows suspicious vascular shadows in the abdominal cavity
• Those who have recurrent unexplained abdominal pain and the cause remains unclear through gastrointestinal examination
"Detecting a visceral aneurysm does not mean that surgery will be performed immediately." Zhang Hongkun said that patients do not need to panic excessively, nor can they ignore it. You should go to the vascular surgery department for standardized evaluation and follow up regularly as directed by your doctor. Early detection, standardized evaluation, treatment when necessary, and long-term management can help reduce the risk of aneurysm rupture and major bleeding.
