Book contents
- Frontmatter
- Contents
- List of contributors
- Preface
- Section 1 Cardiac pseudotumors and other challenging diagnoses
- Section 2 Cardiac aneurysms and diverticula
- Section 3 Anatomic variants and congenital lesions
- Section 4 Coronary arteries
- Section 5 Pulmonary arteries
- Section 6 Cardiovascular MRI artifacts
- Section 7 Acute aorta and aortic aneurysms
- Section 8 Post-operative aorta
- Section 9 Mesenteric vascular
- Case 73 Pseudostenosis of the common bile duct from crossing hepatic artery
- Case 74 Pseudometastatic disease from hepatic arterioportal shunts
- Case 75 Pancreatic pseudomass due to thrombosed pseudoaneurysm
- Case 76 Splenic artery aneurysm mimicking pancreatic neuroendocrine tumor
- Case 77 Median arcuate ligament compression
- Case 78 Non-occlusive mesenteric ischemia
- Case 79 Segmental arterial mediolysis
- Case 80 Superior mesenteric artery syndrome
- Case 81 Renal fibromuscular dysplasia
- Case 82 Reversal of superior mesenteric artery and vein in midgut volvulus
- Case 83 Mesenteric artery collateral pathways
- Case 84 Mesenteric artery anatomic variants
- Section 10 Peripheral vascular
- Section 11 Veins
- Index
- References
Case 75 - Pancreatic pseudomass due to thrombosed pseudoaneurysm
from Section 9 - Mesenteric vascular
Published online by Cambridge University Press: 05 June 2015
- Frontmatter
- Contents
- List of contributors
- Preface
- Section 1 Cardiac pseudotumors and other challenging diagnoses
- Section 2 Cardiac aneurysms and diverticula
- Section 3 Anatomic variants and congenital lesions
- Section 4 Coronary arteries
- Section 5 Pulmonary arteries
- Section 6 Cardiovascular MRI artifacts
- Section 7 Acute aorta and aortic aneurysms
- Section 8 Post-operative aorta
- Section 9 Mesenteric vascular
- Case 73 Pseudostenosis of the common bile duct from crossing hepatic artery
- Case 74 Pseudometastatic disease from hepatic arterioportal shunts
- Case 75 Pancreatic pseudomass due to thrombosed pseudoaneurysm
- Case 76 Splenic artery aneurysm mimicking pancreatic neuroendocrine tumor
- Case 77 Median arcuate ligament compression
- Case 78 Non-occlusive mesenteric ischemia
- Case 79 Segmental arterial mediolysis
- Case 80 Superior mesenteric artery syndrome
- Case 81 Renal fibromuscular dysplasia
- Case 82 Reversal of superior mesenteric artery and vein in midgut volvulus
- Case 83 Mesenteric artery collateral pathways
- Case 84 Mesenteric artery anatomic variants
- Section 10 Peripheral vascular
- Section 11 Veins
- Index
- References
Summary
Imaging description
Pseudoaneurysm, also known as a false aneurysm, is a collection of flowing blood that is encapsulated and communicates with the ruptured arterial lumen contained only by the adventitia or surrounding soft tissue. After contrast administration, the sac may fill with contrast material if it is not completely thrombosed and the enhancement follows that of the feeding artery (Figures 75.1 and 75.2). Thrombus within the sac may appear as high-attenuation filling defect on unenhanced CT or as high-signal-intensity defect on fat-suppressed T1-weighted MR images. Diagnostic specificity may be improved with 3D multidetector CT angiography (Figure 75.3). Three- dimensional renderings are valuable for distinction from tortuous vessel or small, hyperattenuating islet cell tumor of the pancreas. Conventional angiography remains the standard of reference and provides the capability of endovascular management (Figure 75.4).
Importance
Pseudoaneurysms complicate 10% of cases of acute pancreatitis, most commonly affecting the splenic artery, although the hepatic, gastric, gastroduodenal, and pancreaticoduodenal arteries may also be involved due to erosion by pancreatic enzymes. Early detection and management are paramount given the high mortality associated with rupture, which may be up to 90% if bleeding is left untreated. Rupture can occur into the peritoneum, adjacent hollow organs, pseudocyst or pancreatic duct. Given enhancement characteristics, there is risk of mistaking pseudoaneurysms for a hypervascular pancreatic mass such as neuroendocrine tumor. Misdiagnosis leading to biopsy may have catastrophic consequences due to severe bleeding.
Typical clinical scenario
Pseudoaneurysm may be asymptomatic and could be detected incidentally during imaging patients with complicated pancreatitis and may be mistaken for a mass at routine imaging, especially if the lumen is completely thrombosed and fails to enhance on CT. In case of hyperenhancement, it may also be mistaken for a hypervascular lesion such as a neuroendocrine tumor.
- Type
- Chapter
- Information
- Pearls and Pitfalls in Cardiovascular ImagingPseudolesions, Artifacts, and Other Difficult Diagnoses, pp. 239 - 240Publisher: Cambridge University PressPrint publication year: 2015