Rupture of pseudoaneurysm of the pancreaticoduodenal arcade after acute aortic dissection in a patient on anticoagulant therapy

Taniai, Seiichi; Nagai, Wataru; Shimizu, Hisashi; Masuda, Yutaka; Nitatori, Toshiaki; Yoshino, Hideaki

doi:10.1016/j.jccase.2010.12.003

Cited by 3 publications

(4 citation statements)

References 9 publications

(7 reference statements)

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“…Rupture of the pancreaticoduodenal aneurysm with aortic dissection has been reported in the setting of anticoagulation. 5 The clinical picture of our patient favours atypical mediumand large-vessel vasculitis of unknown subtype. Nonspecific inflammatory markers remained elevated three months after presentation, which supports a diagnosis of vasculitis.…”

Section: Discussionmentioning

confidence: 57%

Visceral artery aneurysms: an atypical presentation of large-vessel vasculitis

Litt

Mussari

Gauvin

et al. 2016

CMAJ

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A 79-year-old woman with atrial fibrillation, hypertension and hypothyroidism presented to the emergency department with syncope. She had previously experienced three minor syncopal episodes. A few months earlier, she had been prescribed rivaroxaban 15 mg/d after many years of warfarin therapy. On the day of presentation, she had woken feeling weak and fell to the floor, but managed to call 911. Following the initial assessment by emergency medical services she became unresponsive and briefly pulseless, and cardiopulmonary resuscitation was performed.In the emergency department, the patient was resuscitated with several boluses of normal saline, one unit each of packed red blood cells, platelets and prothrombin complex concentrate. Her vital signs stabilized. Diffuse abdominal guarding and tenderness were noted on examination. No prior intra-abdominal surgery was reported, and there was no definite antecedent infection.The patient's leukocyte count was 19.9 (normal 4.0-10.5) × 10 9 /L, plasma lactate level 12.4 (normal 0.5-2.2) mmol/L and hemoglobin 83 (normal 120-160) g/L; her hemoglobin level had been 121 g/L two months earlier. The international normalized ratio was 4.2 (normal 0.9-1.1). The platelet count and lipase level were within normal limits.Contrast-enhanced computed tomography (CT) showed a large intraperitoneal hematoma centred on a 3-cm pseudoaneurysm in the expected location of the pancreaticoduodenal arteries ( Figure 1). There were several smaller fusiform aneurysms arising from the celiac and superior mesenteric branch vessels. In the descending thoracic and abdominal aorta, there was an intramural hematoma, with active filling of multiple penetrating ulcerations ( Figure 2).Interventional radiology was consulted for angiography and potential transcatheter embolization. Angiography confirmed the CT findings, including a 3-cm pseudoaneurysm arising from the inferior pancreaticoduodenal artery. The artery was selected with a Progreat microcatheter (Terumo Interventional Systems), and the segments of the artery proximal and distal to the 3-cm ruptured pseudoaneurysm were embolized with five Nester embolization coils 3 mm × 14 cm (Cook Medical) and two Interlock embolization coils 3 mm × 12 cm (Boston Scientific) ( Figure 3).Angiography of the celiac and superior mesenteric arteries showed many smaller aneurysms involving several branch vessels. Given that these aneurysms were not easily accessible and did not meet the size criteria of 2 cm, they were not embolized. The interventional radiologist suspected vasculitis as the underlying cause. The smaller aneurysms were therefore expected to respond to medical therapy and did not require immediate intervention.Following endovascular coiling, investigations showed an increase in nonspecific inflammatory markers, including a C-reactive protein level of 180.1 (normal 0-1.0) mg/L and an erythrocyte sedimentation rate of 60 (normal 0-27) mm/h. Results of serologic evaluations were within normal limits, including tests for antineutrophil antibodies, anti-ex...

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Section: Discussionmentioning

confidence: 57%

Visceral artery aneurysms: an atypical presentation of large-vessel vasculitis

Litt

Mussari

Gauvin

et al. 2016

CMAJ

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“…9 Pseudoaneurysm is easy to occur in the elderly patients with arteriosclerosis and patients who take anticoagulants. 10,11 However, the patient in our study was a healthy woman. The hematoma gradually occurs after the bandage is removed at 48 hour after UGVAB.…”

Section: Discussionmentioning

confidence: 89%

Microwave ablation of breast pseudoaneurysm

Cai¹,

Ning²,

Dong³

et al. 2021

Pak J Med Sci

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Breast pseudoaneurysm is a very rare complication. In this study, we report a patient with huge breast pseudoaneurysm after ultrasound-guided vacuum-assisted biopsy (UGVAB) of breast nodules. In treatment, we used microwave ablation to treat the pseudoaneurysm, and then used UGVAB again to eliminate the complicated hematoma. The patients obtained good therapeutic effect. From this case, we experience that, before the interventional operations for breast nodules, the systematic ultrasound examination should be performed. In the needle entering channel, the obvious blood vessels should be avoided to reduce the unnecessary vascular injury. When the pseudoaneurysm occurs, the patient’s condition, pseudoaneurysm situation and hematoma size should be comprehensively considered, combined with the multidisciplinary consultation, for selecting the best treatment strategy. doi: https://doi.org/10.12669/pjms.38.1.4930 How to cite this:Cai Z, Ning R, Dong W, Zhang Y. Microwave ablation of breast pseudoaneurysm. Pak J Med Sci. 2022;38(1):---------. doi: https://doi.org/10.12669/pjms.38.1.4930 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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“…Typically however, aneurysms secondary to increased flow would occur over months to years. Cases have also been described in the setting of anticoagulation, but a causal relationship is yet to be determined 1,7,8 …”

Section: Figmentioning

confidence: 99%

“…Cases have also been described in the setting of anticoagulation, but a causal relationship is yet to be determined. 1,7,8 Failure to recognize VAAs can have life threatening consequences. For this patient, surgical review of images was required to reach the correct diagnosis.…”

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confidence: 99%

Correct identification of visceral artery aneurysms is critical

Hunt

Cavallucci

Boyne

et al. 2023

ANZ Journal of Surgery

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Visceral artery aneurysms (VAAs) are rare, with high morbidity and mortality. Correct identification of VAAs on abdominal imaging is critical; misdiagnosis and failure to treat predisposes the patient to significant risk of rupture and death. In this case report, we present a case of a patient with a primary giant hepatic artery aneurysm, initially mistaken for a pancreatic tumour.A 70-year-old male suffered 3 episodes of epigastric pain over 3 months. Each episode involved the sudden onset of moderately severe epigastric pain lasting 3 hours. There were no identifiable triggers. The patient had a history of atrial fibrillation, treated with rivaroxaban. He had had no previous abdominal surgery or pancreatitis. Physical examination findings were unremarkable. Biochemical investigations revealed no abnormalities.Abdominal ultrasound suggested a 5 Â 4 Â 5 cm complex mass in the pancreatic head. Abdominal CT with IV contrast was performed (Fig. 1). The initial radiology report described a pancreas mass with a dilated hepatic artery nearby.HPB multidisciplinary review of the images diagnosed a partially thrombosed, giant hepatic artery aneurysm measuring 4 Â 5 cm, arising just distal to the common hepatic artery origin. The patient

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Rupture of pseudoaneurysm of the pancreaticoduodenal arcade after acute aortic dissection in a patient on anticoagulant therapy

Cited by 3 publications

References 9 publications

Visceral artery aneurysms: an atypical presentation of large-vessel vasculitis

Visceral artery aneurysms: an atypical presentation of large-vessel vasculitis

Microwave ablation of breast pseudoaneurysm

Correct identification of visceral artery aneurysms is critical

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