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Yang Y, Liu XM, Li HP, Xie R, Tuo BG, Wu HC. Pancreatic pseudoaneurysm mimicking pancreatic tumor: A case report and review of literature. World J Gastrointest Oncol 2023; 15:2041-2048. [DOI: 10.4251/wjgo.v15.i11.2041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/04/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Pancreatic pseudoaneurysm is a rare vascular complication of chronic pancreatitis (CP) or necrotizing pancreatitis with an incidence of 4% to 17%, but it is potentially life-threatening. It is well known that most pancreatic pseudoaneurysms are clinically associated with pancreatic pseudocysts and are usually in the peripancreatic body-tail. A minority of intrapancreatic pseudoaneurysms occur in the absence of pseudocyst formation. Noninvasive computed tomography (CT) and magnetic resonance imaging (MRI) are most commonly used examinations for screening pancreatic pseudoaneurysms. Notably, the rare intrapancreatic pseudoaneurysm in the pancreatic head can mimic a hypervascular solid mass and be misdiagnosed as a pancreatic tumor.
CASE SUMMARY We report the case of a 67-year-old man who had been admitted to our hospital due to recurrent abdominal pain for 1 mo that was aggravated for 5 d. CT and MRI revealed a mass in the pancreatic head with significant expansion of the main pancreatic duct and mild atrophy of the pancreatic body-tail. He was admitted to the department of hepatobiliary and pancreatic surgery due to the possibility of a pancreatic tumor. The patient was then referred for endoscopic ultrasonography (EUS) with possible EUS-FNA. However, EUS showed a cystic lesion in the pancreatic head with wall thickness and enhancing nodules, which was doubtful because it was inconsistent with the imaging findings. Subsequently, color doppler flow imaging demonstrated turbulent arterial blood flow in the cystic lesion and connection with the surrounding vessel. Therefore, we highly suspected the possibility of CP complicated with intrapancreatic pseudoaneurysm, combined with the patient's long-term drinking history and the sonographic features of CP. Indeed, angiography revealed an oval area of contrast medium extravasation (size: 1.0 cm × 1.5 cm) at the far-end branch of the superior pancreaticoduodenal artery, and angiographic embolization was given immediately at the same time.
CONCLUSION EUS is an important differential diagnostic tool when pancreatic pseudoaneurysm mimics the imaging appearance of a hypervascular pancreatic tumor.
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Affiliation(s)
- Yuan Yang
- Department of Gastroenterology, Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Xue-Mei Liu
- Department of Gastroenterology, Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Hong-Ping Li
- Department of Gastroenterology, Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Rui Xie
- Department of Gastroenterology, Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Bi-Guang Tuo
- Department of Gastroenterology, Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Hui-Chao Wu
- Department of Gastroenterology, Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
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Gupta S, Mohta A, Thameem D. A Case of the Unveiling of Pulmonary Pseudoaneurysm Masquerading as a Lung Mass. Cureus 2023; 15:e38151. [PMID: 37252577 PMCID: PMC10224704 DOI: 10.7759/cureus.38151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 05/31/2023] Open
Abstract
Pulmonary artery pseudoaneurysm (PAP) is an abnormal dilatation of the pulmonary vessels. They can mimic the appearance of lung nodules on chest X-rays and noncontrast CT imaging of the chest. We present a case of PAP masquerading as a lung mass for five years before presenting as a pulmonary hematoma. Our patient was an elderly male who presented to the emergency department with dizziness and weakness. He had been on regular follow-ups with annual noncontrast CT scans for a stable lung mass for the past five years. A contrast-enhanced chest CT scan on presentation showed a right lower lobe pseudoaneurysm ruptured into the pleural space with hemothorax, which was confirmed on subsequent chest CTA. The patient underwent an emergent right lower lobe resection and recovered uneventfully. Differentiating a PAP from a lung nodule is challenging and is often missed even by radiologists. A nodule or mass along the pulmonary arterial tree should raise suspicion and trigger further contrast-enhanced imaging, especially angiography, to confirm the diagnosis.
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Affiliation(s)
- Sushan Gupta
- Internal Medicine, Carle Foundation Hospital, Champaign, USA
| | - Avani Mohta
- Internal Medicine, Carle Foundation Hospital, Champaign, USA
| | - Danish Thameem
- Critical Care, Carle Foundation Hospital, Champaign, USA
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Giant pulmonary pseudoaneurysm following balloon dilatation of the pulmonary artery to relieve pulmonary band. Cardiol Young 2022; 33:832-834. [PMID: 36120917 DOI: 10.1017/s1047951122002980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Pulmonary artery pseudoaneurysms are uncommon. They may occur secondary to trauma, infectious diseases, vasculitis syndromes, neoplasms, congenital diseases, and pulmonary hypertension. Due to increasing number of cardiac interventions, iatrogenic complications are among the major causes of pulmonary artery pseudoaneurysms.In this report, we present a 6-month-old patient with pulmonary pseudoaneurysm that occurred following pulmonary balloon angioplasty for the relief of a pulmonary band.
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Computed Tomography Appearance of Unusual Nonaortic Thoracic Aneurysms and Pseudoaneurysms. J Thorac Imaging 2021; 36:W96-W104. [PMID: 32433434 DOI: 10.1097/rti.0000000000000521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although aneurysms of the thoracic aorta are easily recognized on computed tomography (CT), nonaortic intrathoracic aneurysms and pseudoaneurysms are unusual and not often encountered by radiologists. These lesions can result in complications such as hemorrhage or symptoms from mass effect. In some cases, patients may be asymptomatic and the aneurysms may represent incidental findings. Radiologists should be familiar with the CT appearances of these rare vascular abnormalities to enable prompt diagnosis. The goals of this pictorial essay are to: (1) illustrate and describe the CT appearances of various unusual intrathoracic nonaortic aneurysms and pseudoaneurysms; (2) discuss the etiology and clinical significance of these lesions; and (3) discuss management options where appropriate.
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Borghese O, Ganimede MP, Briatico Vangosa A, Pisani A, Vidali S, Di Stasi C, Burdi N, Semeraro V. The Minimally Invasive Treatment of Visceral Artery Pseudoaneurysms: A Retrospective Observational Single Centre Cohort Study on Glue Embolization. Vasc Endovascular Surg 2021; 55:831-837. [PMID: 34261391 DOI: 10.1177/15385744211028730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The objective is to report a single centre experience in the embolization of visceral artery pseudoaneurysms with N-butyl-cyanoacrylate-methacryloxy sulfolane (NBCA-MS). METHODS A retrospective observational cohort study was conducted on data about all consecutive patients treated for visceral artery pseudoaneurysms in the Interventional Radiology Unit of SS Annunziata Hospital, in Taranto (Italy) between January 2016 and July 2020. Only patients treated with NBCA-MS embolization were included. Clinical and technical outcomes were evaluated during in-hospital stay and at 3-month follow-up by computed angiotomography (CTA). RESULTS Among 89 patients undergoing treatment for visceral artery pseudoaneurysm, a total of 58 (65.2%) patients (n = 32, 55.2% men; median age 45.8 years, range: 35-81) treated with NBCA-MS only were enrolled. Pseudoaneurysms were located in the renal artery (n = 18 cases, 31%), in the splenic artery (n = 27, 46.6%), in the intra-parenchymal hepatic artery (n = 3, 5.2%), in the common hepatic artery (n = 4, 6.9%) or in the pancreatic artery (n = 6, 10.3%). N-butyl-cyanoacrylate was diluted 1:1 with Lipiodol ultra-fluid, and mean volume injected was 0.6 ± 0.3 mL (range: 0.2-2.8 mL). Embolization was technically and clinically successful in all patients (n = 58, 100%) with an immediate total thrombosis of the pseudoaneurysm at the completion angiography. No systemic complications were noted in all cases. Five cases (8.6%) of non-target vessel embolization occurred without any clinical complication. No pseudoaneurysm recurrence was detected at the CTA control 1 day postoperatively. In one case (1.7%), a recurrence was detected 4 days after the initial treatment and successfully managed by a repeated NBCA-MS embolization. During the hospital stay, 56 patients recovered well but 2 (3.4%) died from multi-organ failure not related to the embolization. No recurrences were detected at the 3-month postoperative CTA in the remaining patients. CONCLUSIONS In properly selected patients affected with visceral artery pseudoaneurysms, NBCA-MS represents a definitive and safe embolization agent.
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Affiliation(s)
- Ottavia Borghese
- Department of Vascular and Endovascular Surgery, 55183Nord Laennec Hospital, Saint-Herblain, France.,9311University Sapienza of Rome, Rome, Italy
| | | | | | - Angelo Pisani
- Department of Cardiothoracic Surgery, 47165Pinata Grande Hospital, Castel Volturno, Italy
| | | | - Carmine Di Stasi
- Interventional Radiology Unit, 170131SS Annunziata Hospital, Taranto, Italy
| | - Nicola Burdi
- Interventional Radiology Unit, 170131SS Annunziata Hospital, Taranto, Italy
| | - Vittorio Semeraro
- Interventional Radiology Unit, 170131SS Annunziata Hospital, Taranto, Italy
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Kang T, Kang MJ. Pulmonary artery pseudoaneurysm showing rapid growth in a patient with lung cancer. Radiol Case Rep 2020; 15:2144-2148. [PMID: 32952752 PMCID: PMC7484516 DOI: 10.1016/j.radcr.2020.07.077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 11/30/2022] Open
Abstract
Pulmonary artery pseudoaneurysm is rare and is usually associated with infection. In this report, we describe the case of a patient with pulmonary artery pseudoaneurysm in association with pulmonary squamous cell carcinoma. A 64-year-old man with a previous history of lung cancer showed massive hemoptysis and large consolidation in the right lower lung. Emergency radiologist interpreted this lesion as cancer progression or hematoma. Thus, emergency bronchial and intercostal angiography were performed. However, during admission, the patient presented with another episode of massive hemoptysis. A thoracic radiologist reviewed the previous computed tomography scans and noted the presence of a large hematoma in the right lower lobe of the lung; a pseudoaneurysm was seen within the hematoma arising from the pulmonary artery. On follow up computed tomography, the pseudoaneurysm showed rapid growth. Thus, the patient underwent embolization for the branch of the right lower lobar pulmonary artery using coil and histoacryl. Misdiagnosis of pulmonary artery pseudoaneurysm could be fatal; hence, radiologists should be familiar with the features of pulmonary artery pseudoaneurysm.
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Affiliation(s)
- Taekyung Kang
- Department of Emergency Medicine, Inje University, Sanggye Paik Hospital, Seoul, South Korea
| | - Mi-Jin Kang
- Department of Radiology, Inje University, Sanggye Paik Hospital, Seoul, South Korea
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Kwok AMF. Atraumatic splenic rupture after cocaine use and acute Epstein-Barr virus infection: A case report and review of literature. World J Gastrointest Surg 2019; 11:433-442. [PMID: 31879535 PMCID: PMC6912070 DOI: 10.4240/wjgs.v11.i12.433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/05/2019] [Accepted: 11/21/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Atraumatic splenic rupture (ASR) accounts for just over 3% of all cases of splenic rupture and is associated with a high mortality rate. The most common culprit is acute infection with Epstein-Barr virus (EBV) but other documented aetiologies include neoplasia, other viral/bacterial infections, acute and chronic pancreatitis, amyloidosis and anticoagulant medications. There are four previous reports of cocaine-associated ASR but never before has it been documented in combination with concurrent acute EBV infection.
CASE SUMMARY A 21-year-old man presented to hospital with acute left shoulder pain which radiated to the right shoulder and upper abdomen. He denied any history of recent trauma and had no relevant past medical history. He took no regular prescription medications but had used cocaine within the previous 24 h. Investigations revealed splenomegaly, a Grade 3 subcapsular splenic haematoma, moderate haemoperitoneum and an incidental 9 mm splenic artery pseudoaneurysm. There was also serological evidence of acute EBV infection. Prophylactic endovascular embolisation of the pseudoaneurysm was performed and the splenic rupture was managed non-operatively. The patient remained admitted in hospital for seven days and did not require any transfusion of blood products. Serial imaging showed complete resolution of the haemoperitoneum after 5 wk. The importance of abstinence from illicit drug use was emphasised to the patient but it is unknown whether or not he remains compliant.
CONCLUSION This case demonstrates that ASR is a rare condition that can result from acute EBV infection and cocaine ingestion and requires a high index of suspicion to diagnose clinically.
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Affiliation(s)
- Allan Mun Fai Kwok
- Department of Surgery, Wollongong Hospital, Wollongong 2500, NSW, Australia
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Guillaume B, Vendrell A, Stefanovic X, Thony F, Ferretti GR. Acquired pulmonary artery pseudoaneurysms: a pictorial review. Br J Radiol 2017; 90:20160783. [PMID: 28337922 DOI: 10.1259/bjr.20160783] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Pulmonary artery pseudoaneurysms (PAPs) are uncommon but potentially lethal. They may be incidentally discovered on imaging, or following massive haemoptysis if they rupture, with high risk of mortality. The most frequent causes of PAP are trauma and infectious disease. Vasculitis, in particular Behçet's disease, neoplasm, congenital disease and pulmonary hypertension are rarer causes of PAP. A PAP can be suspected from chest X-ray and contrast CT, but requires confirmation by CT angiography. Arteriography is no longer performed for diagnostic purposes, but can be useful in preparing endovascular occlusion of the PAP. In rare cases, surgery is necessary. The aim of this pictorial review was to illustrate the most common causes of acquired PAPs.
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Affiliation(s)
- Benedicte Guillaume
- 1 Clinique Universitaire de Radiologie et Imagerie Médicale, Centre Hospitalier Universitaire A Michallon, Grenoble, France.,2 Université Grenoble Alpes, Grenoble, France
| | - Anne Vendrell
- 1 Clinique Universitaire de Radiologie et Imagerie Médicale, Centre Hospitalier Universitaire A Michallon, Grenoble, France.,2 Université Grenoble Alpes, Grenoble, France
| | - Xavier Stefanovic
- 3 Service de radiologie, Centre Hospitalier Universitaire de Nimes, Nimes, France
| | - Frederic Thony
- 1 Clinique Universitaire de Radiologie et Imagerie Médicale, Centre Hospitalier Universitaire A Michallon, Grenoble, France.,2 Université Grenoble Alpes, Grenoble, France
| | - Gilbert R Ferretti
- 1 Clinique Universitaire de Radiologie et Imagerie Médicale, Centre Hospitalier Universitaire A Michallon, Grenoble, France.,2 Université Grenoble Alpes, Grenoble, France
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Madhusudhan KS, Venkatesh HA, Gamanagatti S, Garg P, Srivastava DN. Interventional Radiology in the Management of Visceral Artery Pseudoaneurysms: A Review of Techniques and Embolic Materials. Korean J Radiol 2016; 17:351-63. [PMID: 27134524 PMCID: PMC4842855 DOI: 10.3348/kjr.2016.17.3.351] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 01/25/2016] [Indexed: 12/15/2022] Open
Abstract
Visceral artery pseudoaneurysms occur mostly as a result of inflammation and trauma. Owing to high risk of rupture, they require early treatment to prevent lethal complications. Knowledge of the various approaches of embolization of pseudoaneurysms and different embolic materials used in the management of visceral artery pseudoaneurysms is essential for successful and safe embolization. We review and illustrate the endovascular, percutaneous and endoscopic ultrasound techniques used in the treatment of visceral artery pseudoaneurysm and briefly discuss the embolic materials and their benefits and risks.
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Affiliation(s)
| | | | - Shivanand Gamanagatti
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Pramod Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Deep Narayan Srivastava
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India
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