EURORAD ESR

Case 10271

An uncommon cause of digestive bleeding: diagnostic approach and interventional treatment

Author(s)
Matteoli Marco, Tesei Jacopo, Rossi Michele, David Vincenzo

Sant'Andrea Hospital, II Faculty of medicine "La Sapienza, Radiology; via di grottarossa 1035 Roma, Italy; Email:marcomatteoli@email.it
 
Patient
male, 45 year(s)
 
 
  • Figure 1
    Digestive endoscopy findings

    A neo formation jutting out the lumen, and covered with hyperplastic mammillated mucosal, with a bleeding focal corrosion in the central region.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Endoscopy; Special Focus: Blood;
     
     
  • Figure 2
    16RowMDCT evaluation in arterial and venous phase
     

    A pseudo-nodular injury at the tail of the pancreas, after administration of intravenous contrast medium a slow filling in the lesion was seen, arterial phase shows the normal caliper of peripancreatic vessels.

     
    Area of Interest: Abdomen; Imaging Technique: CT-Angiography; Procedure: Catheters; Special Focus: Blood;

    A pseudo-nodular injury at the tail of the pancreas, after administration of intravenous contrast medium filling of the active lesion was seen, most evident in the venous phase.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Embolisation; Special Focus: Blood;

    Slight inhomogeneity of adipose tissue in the pancreatic tail, an irregular appearance of the duct of Wirsung, (black arrow), and intrapancreatic calcification (white arrow), was the CT diagnostic criteria for...

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: eLearning; Special Focus: Inflammation;
     
     
  • Figure 3
    Angiogram of left gastric artery
     

    The angiogram of the left gastric artery showed a contrast blush suggestive of active bleeding.

     
    Area of Interest: Abdomen; Imaging Technique: Fluoroscopy; Procedure: Embolisation; Special Focus: Blood;

    The angiogram of the left gastric artery showed a contrast blush suggestive of active bleeding.

     
    Area of Interest: Abdomen; Imaging Technique: Fluoroscopy; Procedure: Embolisation; Special Focus: Blood;

    A super-selective angiogram of the left gastric artery at the emerging of the pseudo-aneurysm failed, due to arterial spasm, so the embolisation strategy was to close the artery proximately with spongostan.

     
    Area of Interest: Abdomen; Imaging Technique: Fluoroscopy; Procedure: Embolisation; Special Focus: Blood;
     
     
  • Figure 4
    Embolization evaluated with CT examination
     

    The CT performed after the embolisation showed no evidence of arterial hyperdensity within the collection situated among the little curve of the stomach a the pancreatic tail.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Embolisation; Special Focus: Blood;

    The CT performed after the embolisation showed no evidence of venous hyperdensity within the collection situated among the little curve of the stomach a the pancreatic tail.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Embolisation; Special Focus: Blood;
     
     
A neo formation jutting out the lumen, and covered with hyperplastic mammillated mucosal, with a bleeding focal corrosion in the central region.
 
A pseudo-nodular injury at the tail of the pancreas, after administration of intravenous contrast medium a slow filling in the lesion was seen, arterial phase shows the normal caliper of peripancreatic vessels.
 
A pseudo-nodular injury at the tail of the pancreas, after administration of intravenous contrast medium filling of the active lesion was seen, most evident in the venous phase.
 
Slight inhomogeneity of adipose tissue in the pancreatic tail, an irregular appearance of the duct of Wirsung, (black arrow), and intrapancreatic calcification (white arrow), was the CT diagnostic criteria for chronic pancreatitis.
 
The angiogram of the left gastric artery showed a contrast blush suggestive of active bleeding.
 
The angiogram of the left gastric artery showed a contrast blush suggestive of active bleeding.
 
A super-selective angiogram of the left gastric artery at the emerging of the pseudo-aneurysm failed, due to arterial spasm, so the embolisation strategy was to close the artery proximately with spongostan.
 
The CT performed after the embolisation showed no evidence of arterial hyperdensity within the collection situated among the little curve of the stomach a the pancreatic tail.
 
The CT performed after the embolisation showed no evidence of venous hyperdensity within the collection situated among the little curve of the stomach a the pancreatic tail.
 
 
 
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