PMC9805738_01
Sonographic images demonstrating (A) acute calculous cholecystitis with stone visible and (B) a complex cystic structure in the left upper quadrant.
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She had an incidental note of a complex cystic lesion seen in the left upper quadrant felt to be dilated bowel; however, bowel gasses obscured the pancreas and aorta (Figure 1).
CT angiogram arterial phase axial view demonstrating a 1.1x0.6cm aneurysm adjacent to the pancreas.
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The CT scan revealed a large hematoma (20 cm diameter) in the mid-abdomen adjacent to the pancreas and transverse colon mesentery, associated with a small 1.1x0.6 cm aneurysm of the MCA (Figure 2).
Angiogram demonstrating (A) active blood extravasation from a branch of the middle colic artery (arrow) and (B) coil deployment only in the parent vessel of the small branch possible and this angiogram shows reduced pressure on the aneurysm which still continues to opacify.
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Only proximal coils into small vessels potentially supplying the area were placed (Figure 3).   
CT angiogram arterial phase axial view demonstrating ongoing bleeding from middle colic artery branch (red arrow). Prior coils (blue arrow) and surgical clips at outflow (white arrow) shown.
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She was emergently resuscitated with blood products, and underwent a repeat CT angiogram, which demonstrated the persistence of her MCA aneurysm, just proximal to the site of ligation during her operation (Figure 4).
Post-operative, post-coiling and stent placement image showing no filling of the aneurysm (red arrow). Additional coils (white arrow) and covered superior mesenteric artery stent (blue arrow) shown.
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This effectively stopped the bleeding, and the remainder of the SMA remained patent (Figure 5).