PMC6585408_01
Axial and coronal maximal intensity projection images show multiple aneurysms of intra-abdominal arteries, including branches of the superior mesenteric artery supplying small bowel loops (arrows).
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C4 were normal. Computed tomography angiography of the whole aorta showed multiple intra-abdominal aneurysms and intraparenchymal renal aneurysms (Figure 1).
Superior mesenteric angiogram shows multiple small aneurysms (white dashed arrows) at the jejunal branches of the superior mesenteric artery (SMA). Rupture of one of aneurysm (black dashed arrow) is seen as contrast extravasation (white solid arrow) into a bowel loop. Embolization of this aneurysm was performed using 250-355 microm polyvinyl alcohol particles. Multiple stenoses (black solid arrow) of branches of the SMA are also seen.
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Emergency angiography showed ruptured jejunal arterial aneurysms, and selective arterial embolization was successfully performed (Figure 2).
Summary of hospital course in the present case.. Abbreviations: Hb, hemoglobin; CRP, C-reactive protein; IVCY, intravenous cyclophosphamide; IVIG, intravenous immunoglobulin; IFX, infliximab.
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Therefore, infliximab (a chimeric anti-TNF-alpha monoclonal antibody) 100 mg (6.7 mg/kg/dose) was commenced at 0 (D99), 2, and 4 weeks, then every 4 weeks for 6 months along with the other supportive treatments shown in Figure 3.
Axial maximal intensity projection image shows decreased size of the previously mentioned aneurysms of the branches of the superior mesenteric artery supplying small bowel loops (arrows). Coronal image shows disappearance of the large aneurysm at jejunum after embolization procedure.
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Computed tomography angiography of the whole aorta revealed that some of the aneurysms had decreased in size (Figure 4).