Answer for BIR CoW 15 Nov 2020
PSEUDOCYST OF PANCREAS WITH SPLENIC ARTERY PSEUDO ANEURYSM
Findings
Pancreas appear atrophic with peri pancreatic fat stranding. Multiple well defined peripherally enhancing hypo dense collection noted in paracolic gutter and greater sac measuring 7.8x 5.4 cm E/o contrast filled out pouching noted in splenic artery which is located 1.4 cm proximal to splenic artery bifurcation measuring 1.5x 1.9 cm with neck of outpouching measures 5.2 mm with neck facing posteromedially Pseudo aneurysm is surrounded by hypodense thrombus Superior polar artery of spleen is present which arise from main splenic artery just proximal to neck of pseudoaneurysm. DSA FINDINGS: Under aseptic precaution and local anesthesia , through right femoral route selective catheterisation of femoral arteries done with 5f cobra catheter . Selective catheterization of splenic artery done using microcatheter. Pseudoaneurysm arising from the splenic artery with distal flow present. Catheter passed into the feeding artery and pseudo aneurysm was embolized using two coils (4mm and 6 mm). Post embolisation check angio showed non filling of aneurysm with distal filling of hilum.
Discussion
Acute pseudocyst{>4 wks} collection of pancreatic juice enclosed by a wall of fibrous or granulation tissue. CT-well-circumscribed, low-attenuation collection within or around the pancreas. Most Pseudocysts regress spontaneously. Pseudocysts requiring drainage Large (> 5 cm), unresolving (> 6 weeks), or symptomatic (pain, gastric outlet obstruction, or biliary obstruction), Pseudoaneurysm : May be located in the pancreas, adjacent retroperitoneum or within wall of pancreatic pseudocyst. M/C- splenic, gastroduodenal, pancreaticoduodenal and superior mesenteric arteries 10% of severe acute pancreatitis Pancreatic enzymatic auto digestion of splenic arterial wall causing fragmentation of elastic tissue and weakening of the vessel wall. DOPLER Findings - ying yang sign Non-enhanced CT-hyperdense smooth walled sac adjacent to an artery, usually with communication. CT angiography or DSA – Investigation of choice . Arterial embolization - treatment of choice
Findings
Pancreas appear atrophic with peri pancreatic fat stranding. Multiple well defined peripherally enhancing hypo dense collection noted in paracolic gutter and greater sac measuring 7.8x 5.4 cm E/o contrast filled out pouching noted in splenic artery which is located 1.4 cm proximal to splenic artery bifurcation measuring 1.5x 1.9 cm with neck of outpouching measures 5.2 mm with neck facing posteromedially Pseudo aneurysm is surrounded by hypodense thrombus Superior polar artery of spleen is present which arise from main splenic artery just proximal to neck of pseudoaneurysm. DSA FINDINGS: Under aseptic precaution and local anesthesia , through right femoral route selective catheterisation of femoral arteries done with 5f cobra catheter . Selective catheterization of splenic artery done using microcatheter. Pseudoaneurysm arising from the splenic artery with distal flow present. Catheter passed into the feeding artery and pseudo aneurysm was embolized using two coils (4mm and 6 mm). Post embolisation check angio showed non filling of aneurysm with distal filling of hilum.
Discussion
Acute pseudocyst{>4 wks} collection of pancreatic juice enclosed by a wall of fibrous or granulation tissue. CT-well-circumscribed, low-attenuation collection within or around the pancreas. Most Pseudocysts regress spontaneously. Pseudocysts requiring drainage Large (> 5 cm), unresolving (> 6 weeks), or symptomatic (pain, gastric outlet obstruction, or biliary obstruction), Pseudoaneurysm : May be located in the pancreas, adjacent retroperitoneum or within wall of pancreatic pseudocyst. M/C- splenic, gastroduodenal, pancreaticoduodenal and superior mesenteric arteries 10% of severe acute pancreatitis Pancreatic enzymatic auto digestion of splenic arterial wall causing fragmentation of elastic tissue and weakening of the vessel wall. DOPLER Findings - ying yang sign Non-enhanced CT-hyperdense smooth walled sac adjacent to an artery, usually with communication. CT angiography or DSA – Investigation of choice . Arterial embolization - treatment of choice
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!