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Celiac artery dissection seen with ruptured pancreaticoduodenal arcade aneurysms in two cases of celiac artery stenosis from compression by median arcuate.

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Presentation on theme: "Celiac artery dissection seen with ruptured pancreaticoduodenal arcade aneurysms in two cases of celiac artery stenosis from compression by median arcuate."— Presentation transcript:

1 Celiac artery dissection seen with ruptured pancreaticoduodenal arcade aneurysms in two cases of celiac artery stenosis from compression by median arcuate ligament  Akiko Watanabe, MD, Hiroshi Kohtake, MD, Shigeru Furui, MD, Koji Takeshita, MD, Yuichi Ishikawa, MD, Satoru Morita, MD  Journal of Vascular Surgery  Volume 56, Issue 4, Pages (October 2012) DOI: /j.jvs Copyright © 2012 Society for Vascular Surgery Terms and Conditions

2 Fig 1 a, Postcontrast computed tomography (CT), arterial phase, shows a retroperitoneal hematoma around the pancreatic head. At the medial part of the lesion, a 10-mm large aneurysm (arrow) is seen, suggestive of a hematoma due to aneurysmal rupture. Arrowhead indicates the superior mesenteric artery (SMA). b, Three-dimensional volume-rendered CT angiogram, right anterior oblique view, shows dilated pancreaticoduodenal arcade (PDA) and an aneurysm (arrow) in the anterior pancreaticoduodenal arcade (APDA). c, Postcontrast CT, sagittal reformed image, shows the proximal celiac axis (arrow) to be compressed near the lower end of the muscular diaphragm (arrowhead). It shows stenosis and kinking with minimal poststenotic dilation, creating a hooked appearance that is characteristic of compression by median arcuate ligament (MAL).5 Dissection of the distal celiac axis is also seen. d, Postcontrast CT shows localized dissection of the celiac artery with thrombosis of the pseudolumen (arrow). e, On precontrast CT at the same level as (d), the thrombosed pseudolumen (arrow) shows higher attenuation than the true lumen and aortic lumen, indicating acute dissection.6 f, On superior mesenteric arteriogram, the hepatic arteries are opacified by collateral circulation via dilated PDA. g, Superior mesenteric arteriogram, right anterior oblique view, clearly shows an aneurysm (arrow) in the APDA. h, Superior mesenteric arteriogram after embolization shows disappearance of the aneurysm. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

3 Fig 2 a, Postcontrast computed tomography (CT), arterial phase, shows a retroperitoneal hematoma around the pancreatic head and body. At the central part of the lesion a 12-mm large aneurysm (arrow) is seen, suggestive of a hematoma due to aneurysmal rupture. Arrowhead indicates the superior mesenteric artery (SMA). b, Three-dimensional volume-rendered CT angiogram, right anterior oblique view, shows dilated pancreaticoduodenal arcade (PDA) and an aneurysm (arrow) in the anterior pancreaticoduodenal arcade (ADPA). c, On postcontrast CT, sagittal reformed image, the proximal celiac axis (arrow) shows stenosis and kinking, creating a hooked appearance. Dissection of the distal celiac axis and common hepatic artery is also seen. d, Postcontrast CT shows localized dissection of the celiac artery with thrombosis of the pseudolumen (arrow). e, On precontrast CT at the same level as (d), the thrombosed pseudolumen (arrow) shows higher attenuation than the true lumen and aortic lumen, indicating acute dissection. f, On superior mesenteric arteriogram, the celiac artery territory is opacified by collateral circulation via dilated PDA and dorsal pancreatic artery. An aneurysm (arrow) is seen at the midportion of the APDA. g, Superior mesenteric arteriogram after embolization shows disappearance of the aneurysm. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

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