Routine Ultrasound Can Effectively Detect Large Visceral Artery Aneurysms, Researchers Say

A standard abdominal ultrasound exam may be more powerful than expected—capable of detecting potentially fatal visceral artery aneurysms before they rupture, according to new research presented Thursday.

In a review of more than 12,000 ultrasound scans performed at the Medical University of Lublin in Poland, a team led by Monika Zbroja-Putowska, MD, found that ultrasound (US) was highly effective at identifying unruptured visceral artery aneurysms larger than 2 centimeters—matching CT in diagnostic accuracy for these larger lesions.

“People are not going to the hospital with visceral artery aneurysms because they are mostly asymptomatic,” Dr. Zbroja-Putowska said. “Though they can be life-threatening if ruptured, these aneurysms are often found incidentally.”

The study evaluated routine fasting abdominal US exams in patients ranging from 16 to 85 years old. In 94 individuals—none of whom presented with specific symptoms—visceral aneurysms were identified using B-mode ultrasound alongside color and spectral Doppler. These cases were then confirmed by CT.

More than half of the aneurysms were found in the splenic artery (52 cases), with others located in the hepatic artery, celiac trunk, gastro-duodenal artery, and mesenteric vessels. In 62 patients, the aneurysm exceeded 2 centimeters in diameter—a key threshold for concern. Over a third of these patients were referred directly for emergency embolization, with successful outcomes.

In one notable case, a pregnant woman with no distinct symptoms was found to have a 20-millimeter splenic artery aneurysm on routine US. She was treated before rupture occurred.

“When it comes to mortality in the rupture of visceral arteries, it’s normally up to 25%,” said Dr. Zbroja-Putowska. “But in pregnant women, we see up to an 80% mortality. That’s a very big difference, and it’s very important to remember. This patient was successfully embolized thanks to a routine ultrasound.”

While ultrasound performed well for larger aneurysms, Dr. Zbroja-Putowska acknowledged its limitations: it is less sensitive for detecting aneurysms under 2 centimeters and can be compromised in emergency situations involving vessel rupture or free intraperitoneal blood. In such cases, CT remains the superior modality.

Even so, she emphasized that ultrasound’s accessibility, low cost, and radiation-free profile make it an ideal screening tool—particularly when used with Doppler techniques and appropriate preparation.

“We should use the appropriate imaging techniques, such as B-flow and Doppler modalities—color, pulsed and power Doppler—for more precise evaluation of vessel morphology and hemodynamic flow parameters,” she said, stressing the importance of patient preparation. “We can avoid the instances where the patient says, ‘Oh, I just had a small sandwich,’ and then we cannot see anything.”

With visceral aneurysms often silent until rupture, Dr. Zbroja-Putowska advocates incorporating vascular assessment into annual abdominal ultrasound exams, especially in older adults.

“When it comes to bigger arterial aneurysms, which can be life-threatening, it’s really important to have them properly measured to find out whether they’re bigger or not,” she said.