Mărginean Lucian, Mureșan Adrian Vasile, Arbănași Emil Marian, Coșarcă Cătălin Mircea, Arbănași Eliza Mihaela, Russu Eliza, Filep Rares Cristian, Kaller Réka
Department of Radiology, Mureș County Emergency Hospital, 540136 Targu Mures, Romania.
Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania.
Diagnostics (Basel). 2023 Mar 14;13(6):1090. doi: 10.3390/diagnostics13061090.
We presented a 67-year-old woman with lightheadedness, diaphoresis, and acute epigastric and right hypochondrium pain, with a past medical history including stage 2 essential hypertension, chronic ischemic cardiomyopathy, and class 1 obesity. An abdominal contrast-enhanced CT scan showed an extensive hematoma (3 × 4 cm in size) located intra-abdominally, adjacent to the duodenojejunal area, with hyperdensity around the duodenum, positioned inferior to the pancreas (30-59 HU). Moreover, the CT scan also revealed an enhancing lesion as a pseudoaneurysm of the inferior pancreaticoduodenal artery, measuring 5 × 8 × 8 mm with active bleeding and associated hematoma. Following these investigations of the abdominal area, a decision was made to proceed with an endovascular intervention within the interventional radiology department. With the patient under conscious sedation, via a right common femoral artery approach, the superior mesenteric artery was catheterized. While injecting the contrast agent to obtain a better working projection, the pseudoaneurysm ruptured, and acute extravasation of the contrast agent was noted, followed by injection of a mixture of 1 mL Glubran 2 with 2 mL Lipiodol until complete obliteration of the pseudoaneurysm was obtained. The patient was hemodynamically stable at the end of the procedure and was discharged 6 days later in a good condition without active bleeding signs.
我们接诊了一名67岁女性，她有头晕、多汗症状，伴有上腹部和右季肋区急性疼痛，既往病史包括2级原发性高血压、慢性缺血性心肌病和1级肥胖症。腹部增强CT扫描显示腹腔内有一个广泛的血肿（大小为3×4厘米），毗邻十二指肠空肠区域，十二指肠周围密度增高，位于胰腺下方（30 - 59 HU）。此外，CT扫描还发现一个强化病变，为胰十二指肠下动脉假性动脉瘤，大小为5×8×8毫米，有活动性出血及相关血肿。在对腹部进行这些检查后，决定在介入放射科进行血管内介入治疗。在患者清醒镇静状态下，经右股总动脉途径，将导管插入肠系膜上动脉。在注射造影剂以获得更好的工作投照时，假性动脉瘤破裂，观察到造影剂急性外渗，随后注射1毫升Glubran 2与2毫升碘油的混合物，直至假性动脉瘤完全闭塞。手术结束时患者血流动力学稳定，6天后出院，情况良好，无活动性出血迹象。
