PMC6276472_01
Case 1: Figures 1(a), 1(b), and 1(c). (a) Axial CT scan showing active contrast extravasation in the region of greater omentum. (b) Coronal MIP image showing actively bleeding aberrant artery arising from the splenic artery (arrow) and extending diagonally into the right iliac fossa, supplying the fat containing lesion (arrow head ). (c) Pre-embolization angiogram depicting the aberrant artery (blue arrow ). There is active contrast extravasation inferiorly (red arrow head ).
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A CT mesenteric angiogram showed a large volume hemoperitoneum and active contrast extravasation in the region of the greater omentum (Figures 1(a) and 1(b)). Angiogram performed from the splenic artery confirmed the presence of an active haemorrhage from an aberrant artery which extended from the splenic hilum down to the right iliac fossa (Figure 1(c)).
Case 1: Figure 2. Histology: Lipomatous tissue with focal fibrosis and old hemorrhage. There was no evidence of high grade sarcoma. Immunostains for CD31 and CD34 do not show evidence of abnormal vascular proliferation. FISH and MDM2 studies could not be performed due to lack of specimen.
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Pathological specimen of the fat-containing mass demonstrated lipomatous tissue with focal fibrosis and old haemorrhage (Figure 2).
PMC6276472_02
Case 2: Figures 3(a), 3(b), and 3(c). (a) Axial postcontrast CT showing contrast extravasation and surrounding haematoma within the lipomatous lesion (white arrow). Large amount of low density ascities is noted. (b & c): Selective catheterisation of the coeliac axis demonstrated an aberrant artery arising from the splenic artery crossing the midline to the right lower abdomen in the region of the acute haematoma terminating in abnormal cork screw vessels (blue arrows ).
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It showed a 3.3 x 1.9cm haematoma in the sigmoid mesentery with a focus of contrast extravasation in the arterial phase that showed progressive pooling in the portal venous and delayed phases (Figure 3(a)). However, selective catheterization of the coeliac axis showed an aberrant vessel arising from the left gastro-epiploic artery and coursing obliquely to the right lower abdomen in the region of the haematoma (Figure 3(b)). Multiple abnormal vessels with a corkscrew appearance were also seen at the distal aspect of the aberrant artery (Figure 3(c)).
PMC6276472_03
Case 3: Figures 4(a) and 4(b). (a) Axial CT image in the arterial phase showing a large fat-containing mass in the pelvis displacing bowel loops. No contrast extravasation is seen. (b) Coronal MIP CT images in the arterial phase showing aberrant vessel arising from the splenic artery (white arrow) and coursing obliquely from the left hypochondrium to the region of the pelvic mass (white arrowhead).
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There was an incidental finding of a fat-containing mass in the pelvis displacing the adjacent bowel loops (Figure 4(a)). There appeared to be an aberrant vessel arising from the left gastro-epiploic artery supplying the mass (Figure 4(b)).