PMC6139223_01
CT showing pancreas with necrotic fluid collections on axial (a) and coronal (b) sections. Contrast extravasation into the IPDA pseudoaneurysm (red arrows) on axial (c) and coronal (d) sections. Yellow arrowheads point to pancreatic duct stent. Blue arrowheads point to pancreatic fluid collections.
CRIS2018-2354169.001.jpg
PMC6139223_01_CRIS2018-2354169.001.jpg
fig1
CT showed pancreatic tail atrophy from prior necrosis, a new area of necrosis measuring 7.1 x 4.9 x 4.9 cm at the superior aspect of the pancreas body and a new 2.3 x 2.2 x 2.8 cm fluid collection inferior-posterior to the uncinate process. (The latter fluid collection communicated with the second portion of the duodenum on CT and would later be identified as the IPDA pseudoaneurysm.) There was extravasation of contrast within this latter fluid collection, suggestive of active bleeding (Figure 1).
Angiography. (a) Superior mesenteric arteriogram showing pseudoaneurysm at the IPDA (red arrow). (b) Selective catheterization of the IPDA showing active extravasation into the pancreatic duct from the IPDA pseudoaneurysm (red arrow).
CRIS2018-2354169.002.jpg
PMC6139223_01_CRIS2018-2354169.002.jpg
fig2
A superior mesenteric arteriogram showed a pseudoaneurysm arising from the IPDA with intermittent hemorrhage (Figure 2).