PMC6159152_01
Ruptured bilobed 18 mm left gastric artery aneurysm with extravasation of contrast media (black arrow); the bulbous saccular nature of contrast enhancement is suggestive of aneurysm here (compared to the more linear appearance of active haemorrhage extending from this location). Associated anteroposterior scout image shows inferiorly displaced lesser curvature of the stomach (white arrow).
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f1
The anteroposterior scout image showed a large epigastric density displacing the lesser curvature of the stomach inferiorly (Figure 1 white arrow). Post administration of contrast, images showed extremely rapid extravasation of contrast from a ruptured bilobed 18 mm left gastric artery aneurysm (Figure 1 black arrow).
Widespread contrast media leak within the peritoneal cavity. Black arrows indicate blood in the pelvis and left paracolic gutter. White arrows indicate superior displacement of the left lobe of the liver.
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f2
From the time of contrast injection to the time of imaging (approximately 70 s) a very large volume of contrast had extravasated into the peritoneal cavity, and was evident in the pelvis, left paracolic gutter (Figure 2 black arrows) and lesser sac, confirming very rapid bleeding.
Sentinel clot displacing the pancreas head and body posteriorly (arrows).
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f3
This haematoma displaced the gastric lesser curvature inferiorly, the pancreatic head and body posteriorly (Figure 3) and the underside of the left lobe of the liver superiorly.
Haematoma (white arrow) has expanded the oesophageal hiatus, extending in to the chest cavity, compressing the oesophageal lumen and pooling posterior to the right lung. Pleural effusion is present.
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f4
The haematoma was seen extending through the oesophageal hiatus, which was also expanded (Figure 4).
PMC6159152_02