PMC9949516_01
A-F, Imaging of a 63-year-old man with traumatic pancreaticoduodenal artery injury. A, Contrast-enhanced computed tomography (CT) showing a pancreatic head hematoma with extravasation (arrow) in the arterial phase. B, Angiography of the posterior superior pancreaticoduodenal artery (PSPDA) in the first angiography session showed extravasation. C, Celiac artery (CA) angiography showed a cast-like embolization of PSPDA (arrowheads) and disappearance of extravasation, although a pseudoaneurysm of unknown origin (arrow) appeared after embolization with n-butyl-2-cyanoacrylate (NBCA). D, Superior mesenteric artery (SMA) angiography after PSPDA embolization showed no pseudoaneurysm. E, Gastroduodenal arteriography in the second angiography session after stabilization in the intensive care unit showed a residual pseudoaneurysm (arrow), although the culprit vessel could not be identified. F, The final SMA angiograph also shows a residual pseudoaneurysm (arrow) without identification of the culprit vessel. G-L, Imaging of a 67-year-old man with traumatic pancreaticoduodenal artery injury. G, Initial contrast-enhanced CT of the arterial phase showing massive extravasation of the pancreatic head (arrow). H, Extravasation is seen on PSPDA angiography from the CA side in the first angiography session (arrow) and embolized with NBCA. I, Extravasation is seen at the inferior pancreaticoduodenal artery branch from the SMA side (arrow) and embolized using NBCA in combination with microcoils. J, Rebleeding from the dorsal pancreatic artery through the CA side is seen in the second angiography session (arrows) and embolized with NBCA. K, Faint extravasation is seen in the delayed phase of postembolization CA angiography (arrow), but it was difficult to identify the culprit vessel. L, In the third angiography session, extravasation disappeared in both CA and SMA angiographies.
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CT was performed while the patient underwent rapid blood transfusion. Computed tomography in the arterial phase showed a large hematoma around the pancreatic head with extravasation (Fig. 1G) and right diaphragmatic injury. After confirming multiple extravasations by CA and SMA angiography, we performed NBCA embolization of the PSPDA from the CA side and coil embolization of a branch of the inferior pancreaticoduodenal artery (IPDA) from the SMA side (Fig. 1H,I). The IPDA was recanalized with the transverse pancreatic artery branch through the dorsal pancreatic artery from the CA side, then re-embolized with NBCA (Fig. 1J). Although faint extravasation was still seen in the delayed phase of postembolization SMA angiography (Fig. 1K), we transferred the patient to the intensive care unit and planned to repeat the angiographs. SMA angiographies in the radiology department, after coagulopathy correction and antihypertensive therapy, demonstrated that the extravasation had disappeared (Fig. 1L). Subsequently, no clinical signs of rebleeding or pancreatic fistula were noted.
PMC9949516_02
A-F, Imaging of a 63-year-old man with traumatic pancreaticoduodenal artery injury. A, Contrast-enhanced computed tomography (CT) showing a pancreatic head hematoma with extravasation (arrow) in the arterial phase. B, Angiography of the posterior superior pancreaticoduodenal artery (PSPDA) in the first angiography session showed extravasation. C, Celiac artery (CA) angiography showed a cast-like embolization of PSPDA (arrowheads) and disappearance of extravasation, although a pseudoaneurysm of unknown origin (arrow) appeared after embolization with n-butyl-2-cyanoacrylate (NBCA). D, Superior mesenteric artery (SMA) angiography after PSPDA embolization showed no pseudoaneurysm. E, Gastroduodenal arteriography in the second angiography session after stabilization in the intensive care unit showed a residual pseudoaneurysm (arrow), although the culprit vessel could not be identified. F, The final SMA angiograph also shows a residual pseudoaneurysm (arrow) without identification of the culprit vessel. G-L, Imaging of a 67-year-old man with traumatic pancreaticoduodenal artery injury. G, Initial contrast-enhanced CT of the arterial phase showing massive extravasation of the pancreatic head (arrow). H, Extravasation is seen on PSPDA angiography from the CA side in the first angiography session (arrow) and embolized with NBCA. I, Extravasation is seen at the inferior pancreaticoduodenal artery branch from the SMA side (arrow) and embolized using NBCA in combination with microcoils. J, Rebleeding from the dorsal pancreatic artery through the CA side is seen in the second angiography session (arrows) and embolized with NBCA. K, Faint extravasation is seen in the delayed phase of postembolization CA angiography (arrow), but it was difficult to identify the culprit vessel. L, In the third angiography session, extravasation disappeared in both CA and SMA angiographies.
AMS2-10-e823-g002.jpg
PMC9949516_02_AMS2-10-e823-g002.jpg
ams2823-fig-0001
CT was performed while the patient underwent rapid blood transfusion. Computed tomography in the arterial phase showed a large hematoma around the pancreatic head with extravasation (Fig. 1G) and right diaphragmatic injury. After confirming multiple extravasations by CA and SMA angiography, we performed NBCA embolization of the PSPDA from the CA side and coil embolization of a branch of the inferior pancreaticoduodenal artery (IPDA) from the SMA side (Fig. 1H,I). The IPDA was recanalized with the transverse pancreatic artery branch through the dorsal pancreatic artery from the CA side, then re-embolized with NBCA (Fig. 1J). Although faint extravasation was still seen in the delayed phase of postembolization SMA angiography (Fig. 1K), we transferred the patient to the intensive care unit and planned to repeat the angiographs. SMA angiographies in the radiology department, after coagulopathy correction and antihypertensive therapy, demonstrated that the extravasation had disappeared (Fig. 1L). Subsequently, no clinical signs of rebleeding or pancreatic fistula were noted.