PMC6319504_01
a Abdominal CT showing a large periportal nodal mass and b Abdominal PET-CT showing avid tracer uptake
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Fig1
A CT scan of the abdomen and pelvis in the portal-venous phase revealed a 5.3 x 4.7 cm periportal lymph node adjacent to the pancreatic head (Fig. 1 a). Tomography -CT (PET-CT) showed avid tracer uptake (Fig. 1b).
Abdominal CT following one dose of chemotherapy showing necrosis of the periportal nodal mass and erosion of the stent through the bile duct
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Fig2
An urgent portal venous phase CT of the abdomen showed extensive necrosis of the mass with erosion of the metal biliary stent through the bile duct wall causing a large amount of intralesional gas (Fig. 2).
Portal venous phase CT showing a main portal vein pseudoaneurysm closely related to the upper end of the biliary stent
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Fig3
The pseudoaneursym was bulging towards the proximal end of the indwelling biliary stent (Fig. 3).
Direct angiography of the pseudoaneursym pre and post-stenting. a Digital subtraction venogram showing a large portal vein pseudoaneurysm bulging into the proximal end of the common bile duct stent. b Post stent deployment venogram showing immediate exclusion of the portal vein pseudoaneurysm
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Fig4
The pseudoaneurysm was positioned at the anteroinferior edge of the proximal portal vein and was bulging into the proximal end of the biliary stent (Figs. 4a and 5). There was immediate exclusion of the pseudoaneurysm on post deployment venograms (Fig. 4b).
3d CT reconstruction of the covered vascular stent and the biliary stent. 3d reconstruction of a follow-up CT of the abdomen showing the relationship of the portal vein stent and the common bile duct stent. The covered portal vein stent has successfully excluded the pseudoaneurysm
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Fig5
The pseudoaneurysm was positioned at the anteroinferior edge of the proximal portal vein and was bulging into the proximal end of the biliary stent (Figs. 4a and 5).