PMC6381554_01
CT image; pancreatic tail lesion.
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Due to her history of diverticulitis a CT scan of abdomen and pelvis was obtained which revealed a 6.9 x 6.1 cm cystic mass in the tail of the pancreas (Figure 1).
Endoscopy image; extrinsic bulge with erythematous mucosa.
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There was a small central ulceration and erythematous surrounding mucosa (Figure 2).
EUS image; pancreatic tail lesion with anechoic component.
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On EUS, a hypoechoic 5 x 5.15 cm lesion with internal anechoic component (Figure 3) was seen in the tail of the pancreas.
Bleeding splenic artery pseudoaneurysm seen on angiogram.
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Selective splenic artery angiogram confirmed a pseudoaneurysm with active hemorrhage (Figure 4).
Post coil embolization angiogram with no bleeding.
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Coil embolization was performed with 6 mm x 7 cm; 3 mm x 7 cm (2), 3 mm x 5 cm (3) Nester   coils (6 total); postembolization angiography demonstrated no leakage from SAP as well as no forward flow in the splenic artery (Figure 5).
Endoscopy image; ulcer located in distal duodenum.
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EGD was done 5 days later for ongoing drop in hemoglobin with persistent melena. EGD showed no abnormalities in the stomach; therefore the scope was advanced into deep duodenum where a large deep ulcer was seen in the fourth part of the duodenum (Figure 6).
Coronal CT abdomen image showing vascular coils in close proximity of distal duodenum.
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fig7
Multimodality imaging confirmed embolization coil to be in close proximity to the distal duodenum/proximal jejunum (Figure 7) further confirming the site of erosion of SAP in distal duodenum.
CT image: infarcted spleen.
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Near complete splenic infarction was confirmed at 2 months on follow-up CT scan (Figure 8).