EURORAD ESR

Case 14172

Arteriographic diagnosis and treatment of gastric Dieulafoy lesion

Author(s)
João Praia 1, Élia Coimbra 2, Tiago Bilhim 2, Filipe Veloso Gomes 2, Joana Albuquerque 1

(1) Centro Hospitalar Barreiro Montijo, EPE, Imagiology Department
(2) Hospital de Curry Cabral, EPE, Interventional Radiology Department
 
Patient
male, 66 year(s)
 
 
  • Figure 1
    UGI endoscopy showing the gastric fundus lesion
     

    UGI endoscopy showing what was believed at the time to be an ulcerated varicose lesion of the gastric fundus.

     
    Area of Interest: Interventional vascular; Stomach; Imaging Technique: Catheter arteriography; Procedure: Embolisation; Endoscopy; Special Focus: Haemorrhage;

    Post treatment with cyanoacrylate.

     
    Area of Interest: Gastrointestinal tract; Interventional vascular; Vascular; Imaging Technique: Catheter arteriography; Procedure: Embolisation; Special Focus: Haemorrhage;

    Control UGI endoscopy 10 days later showing persistence of an irregular and hypertrophied fold of the gastric fundus.

     
    Area of Interest: Gastrointestinal tract; Interventional vascular; Vascular; Imaging Technique: Catheter arteriography; Procedure: Embolisation; Endoscopy; Special Focus: Haemorrhage;
     
     
  • Figure 2
    Abdominal computed tomography angiography (CTA) demonstrating the Dieulafoy lesion
     

    Abdominal CTA showing voluminous arterial hypertrophy of the gastric fundus, communicating with the spleen by way of the short gastric arteries.

     
    Area of Interest: Vascular; Imaging Technique: Catheter arteriography; CT-Angiography; Procedure: Embolisation; Special Focus: Haemorrhage;

    3-D reconstruction image of the abdominal CTA demonstrating the Dieulafoy lesion, communicating with the spleen by way of the short gastric arteries. Note the independent origin of the left gastric artery from the...

     
    Area of Interest: Vascular; Imaging Technique: Catheter arteriography; CT-Angiography; Procedure: Embolisation; Special Focus: Haemorrhage; Hyperplasia / Hypertrophy;
     
     
  • Figure 3
    Arteriographic diagnosis and treatment of the Diuelafoy's lesion
     

    Selective arteriography of the left gastric artery with a Simmons 1 4Fr catheter and a 2.9 Fr microcatheter shows large arterial hypertrophy of the gastric fundus communicating with the spleen by the short gastric...

     
    Area of Interest: Abdomen; Interventional vascular; Stomach; Imaging Technique: Catheter arteriography; Procedure: Embolisation; Special Focus: Hyperplasia / Hypertrophy;

    Selective arteriography of the left gastric artery with a Simmons 1 4Fr catheter and a microcatheter 2.9 Fr shows large arterial hypertrophy of the gastric fundus communicating with the spleen by the short gastric...

     
    Area of Interest: Stomach; Vascular; Imaging Technique: Catheter arteriography; Procedure: Embolisation; Special Focus: Hyperplasia / Hypertrophy;

    Control image post embolization with the liquid agent SQUID 18, demonstrating exclusion of the Dieulafoy's lesion.

     
    Area of Interest: Stomach; Imaging Technique: Catheter arteriography; Procedure: Embolisation; Special Focus: Hyperplasia / Hypertrophy;

    Arteriography of the superior mesenteric artery revealing exuberant collateral splenic and pancreatic-duodenal circulation, feeding the short gastric arteries and spleen; and the gastric-duodenal and hepatic arteries,...

     
    Area of Interest: Stomach; Vascular; Imaging Technique: Catheter arteriography; Procedure: Embolisation; Special Focus: Hyperplasia / Hypertrophy;
     
     
UGI endoscopy showing what was believed at the time to be an ulcerated varicose lesion of the gastric fundus.
 
Post treatment with cyanoacrylate.
 
Control UGI endoscopy 10 days later showing persistence of an irregular and hypertrophied fold of the gastric fundus.
 
Abdominal CTA showing voluminous arterial hypertrophy of the gastric fundus, communicating with the spleen by way of the short gastric arteries.
 
3-D reconstruction image of the abdominal CTA demonstrating the Dieulafoy lesion, communicating with the spleen by way of the short gastric arteries. Note the independent origin of the left gastric artery from the aorta.
 
Selective arteriography of the left gastric artery with a Simmons 1 4Fr catheter and a 2.9 Fr microcatheter shows large arterial hypertrophy of the gastric fundus communicating with the spleen by the short gastric arteries.
 
Selective arteriography of the left gastric artery with a Simmons 1 4Fr catheter and a microcatheter 2.9 Fr shows large arterial hypertrophy of the gastric fundus communicating with the spleen by the short gastric arteries.
 
Control image post embolization with the liquid agent SQUID 18, demonstrating exclusion of the Dieulafoy's lesion.
 
Arteriography of the superior mesenteric artery revealing exuberant collateral splenic and pancreatic-duodenal circulation, feeding the short gastric arteries and spleen; and the gastric-duodenal and hepatic arteries, respectively.
 
 
 
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