PMC4891628_01
52-year-old woman with gastrointestinal bleeding due to active extravasation from a splenic artery pseudoaneurysm into the pancreatic duct. Tagged red blood cell scan shows active bleeding in the stomach or in the very proximal duodenum (arrow). [Powerpoint Slide]
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This nuclear scan demonstrated evidence of GI bleeding from the distal stomach or proximal duodenum (Figure 1).
Selective celiac arteriography demonstrates an abnormal collection of contrast extravasation supplied by the splenic artery (arrow). 2B. Selective splenic arteriography shows a large irregular pseudoaneurysm (arrows) within the splenic hilum. [Powerpoint Slide]
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A large pseudoaneurysm with active extravasation involving the distal splenic artery was visualized (Figures 2A and 2B).
Completion angiogram after splenic artery embolization with Tornado coils (arrow) reveals occlusion of the splenic artery and absence of flow into the pseudoaneurysm. [Powerpoint Slide]
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Post-embolization angiography was performed, which demonstrated normal left gastric, common hepatic, and gastroduodenal arteries (Figure 3).
Abdominal CT scan obtained 5 days post-embolization shows artifact from metallic coils within the splenic artery and a nonenhancing spleen, compatible with splenic infarction (arrow). [Powerpoint Slide]
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On post-procedure day five, the patient had a 5 mm helical computed tomography (CT) of the abdomen and pelvis, showing complete embolization of the splenic artery and infarction of the spleen (Figure 4), for which she received a pneumococcus vaccination.