Pancreatitis angiography

Fig. 7.6a-d. A 48-year-old man with chronic pancreatitis developed further abdominal pain. CECT revealed a pseudoaneurysm in his lesser sac (a). Selective and super selective angiography failed to demonstrate any source for the pseudoaneurysm (b). It was therefore percutaneously punctured with a 21-Gauge needle (c) and thrombosed with 2000 units of autologous thrombin. CECT at 1 week demonstrated occlusion of the pseudoaneurysm (d)... 

Fig.7.9a,b. A 52-year-old woman with a recent history of gall stone pancreatitis was admitted with further abdominal pain. A CECT scan suggested an aneurysm of uncertain origin. Angiography revealed a true (Type la) aneurysm of an aberrant right hepatic artery (a). CECT had revealed a patent portal vein and so proximal and distal coil embolization was performed (b). There were no further complications and the patient is alive and well at 36 months... 

The author has used percutaneous CT guided thrombin injection in six patients where pancreatitis associated aneurysms could not be seen at selective angiography. The technique is relatively simple, the aneurysm being punctured with a 21-Gauge saline flushed needle under CT guidance... 

Aneurysms and pseudoaneurysms causing haemobilia or associated with pancreatitis are potentially fatal. Imaging, particularly CECT, is vital to their diagnosis. Conservative therapy is a poor option and treatment, which was formally via open surgery, is now best carried out by angiography and percutaneous coil embolization in haemobilia and for Type la and b pancreatitis associated pseudoaneurysms. Percutaneous CT guided thrombin therapy is indicated for Type 2 aneurysms. 

Fishman EK, Horton KM, Urban BA (2000) Multidetector CT angiography in the evaluation of pancreatic carcinoma preliminary observation. J Comput Assist Tomogr 24 849-853... 

Hong KC, Ereeny PC (1999) Pancreatioduodenal arcades and dorsal pancreatic artery comparison of CT angiography with three-dimensional volume rendering, maximum intensity projection and shaded-surface display. AJR AM J Roentgenol 211 337-343... 

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