Pancreatic Pseudoaneurysm Workup

  • Author: Faisal Aziz; Chief Editor: John Geibel, MD, DSc, MA   more...
 
Updated: Nov 29, 2011
 

Imaging Studies

  • Angiography
    • Angiography is the criterion standard to determine diagnosis and treatment (see image below). Digital subtraction provides high-resolution imaging of small arteries and allows percutaneous vascular intervention in the same setting.[6] Splenic artery angiogram demonstrating contrast (wSplenic artery angiogram demonstrating contrast (white arrow) extravasating into a pseudoaneurysm (black arrow).
    • If the patient is hemodynamically stable, performing a preoperative angiogram helps confirm the diagnosis. Angiography defines the character—unique or otherwise—of the lesion and allows therapeutic planning. Angiography greatly facilitates identification of the location and serves as a topographical guide for the pseudoaneurysm, which aids in operative proximal and distal control of the bleeding vessel.
    • Preoperative angiography might constitute an opportunity to gain temporary control over the bleeding vessel by performing transcatheter embolization, thus providing a time window for the surgeon to operate on a high-risk patient under optimum clinical conditions.
  • CT angiography has a sensitivity of up to 94.7% and a specificity of 90% (see image below).[7] A CT scan with intravenous contrast enhancement (aA CT scan with intravenous contrast enhancement (arrow) within a pancreatic pseudocyst indicating the presence of a pseudoaneurysm.
  • Magnetic resonance (MR) angiography is highly sensitive and specific. Limitations of MR angiography include its long study time, availability, high cost, and restrictions for patients with certain implantable devices and hardware.
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Faisal Aziz  MD, Assistant Professor of Surgery, Division of Vascular & Endovascular Surgery, Department of Surgery, Penn State University College of Medicine, Hershey, PA

Faisal Aziz is a member of the following medical societies: American College of Surgeons and American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

John A Savino, MD  Professor of Surgery, Chairman, Director of Residency Program, Department of Surgery, New York Medical College; Director of Surgical Critical Care Fellowship, Director of Surgical Intensive Care Unit, Attending Surgeon, Westchester Medical Center

John A Savino, MD is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Surgeons, American Medical Association, Association for Academic Surgery, Association for Surgical Education, Eastern Association for the Surgery of Trauma, Medical Society of the State of New York, Society for Surgery of the Alimentary Tract, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Critical Care Medicine, and Surgical Infection Society

Disclosure: Nothing to disclose.

Mazen S Itani, MD, FACS  Private Practice in Vascular Surgery, Hackettstown Regional Medical Center

Mazen S Itani, MD, FACS is a member of the following medical societies: American Medical Association

Disclosure: Nothing to disclose.

Nabil Sumrani, MD  Associate Professor, Department of Surgery, Division of Transplantation Surgery, State University of New York Health Science Center at Brooklyn

Nabil Sumrani, MD is a member of the following medical societies: Central Surgical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Alex Jacocks, MD  Program Director, Professor, Department of Surgery, University of Oklahoma School of Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Michael A Grosso, MD  Consulting Staff, Department of Cardiothoracic Surgery, St Francis Hospital

Michael A Grosso, MD is a member of the following medical societies: American College of Surgeons, Society of Thoracic Surgeons, and Society of University Surgeons

Disclosure: Nothing to disclose.

Paolo Zamboni, MD  Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy

Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences

Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA  Vice Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director, Surgical Research, Department of Surgery, Yale-New Haven Hospital

John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract

Disclosure: AMGEN Royalty Consulting; ARdelyx Ownership interest Board membership

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Splenic artery angiogram demonstrating contrast (white arrow) extravasating into a pseudoaneurysm (black arrow).
A CT scan with intravenous contrast enhancement (arrow) within a pancreatic pseudocyst indicating the presence of a pseudoaneurysm.
Preembolization angiogram depicting a splenic artery pseudoaneurysm.
Postembolization angiogram depicting successful coil embolization of the pseudoaneurysm.
 
 
 
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