0:00

Okay, so here we have another

0:02

contrast-enhanced CT scan.

0:03

And let me tell you, this pancreatic case is for

0:06

the heroes among you, but I think it's a good

0:09

principle, and I think it's something to be aware of.

0:10

So I think that it is a valid point here.

0:14

So we have some intrahepatic biliary ductal

0:16

dilatation, as we've seen again and again.

0:19

This time we're seeing, again, a lot

0:20

of gastric varices in this patient.

0:22

They've had pancreatitis, hmm, maybe a couple times.

0:24

Here we have a bunch of peripancreatic fluid as well.

0:28

So we have acute pancreatitis, uh,

0:30

maybe on chronic pancreatitis, because we

0:32

know that the splenic vein is suspect.

0:34

Here we have the portal venous confluence.

0:37

Splenic vein just disappears, but wait a second.

0:40

What's this?

0:42

Mess up in the left upper quadrant.

0:44

Okay, let's go coronal on this, 'cause I think

0:46

that's going to be the best visual for you all.

0:48

And when we come off, we're going to notice that we

0:51

have, this is the splenic artery coming across

0:54

the splenic artery, but we have this little

0:56

nubbin extending off the splenic artery with

0:58

high attenuation, um, within this cavity as well.

1:02

Coming all the way to the spleen

1:03

in the left upper quadrant.

1:05

This is a very small,

1:07

yet can be very deadly, splenic artery pseudoaneurysm.

1:13

You can imagine that if pancreatic juice can eat

1:16

the fat of your body and make it into soap, and

1:19

if this pancreatic juice can cause all of those

1:22

walled-off necrosis, that if you are an artery

1:24

living in pancreatic juice, that's not good for you.

1:27

So this is a splenic

1:29

artery pseudoaneurysm.

1:31

They are frequently about the

1:33

size, just a nubbin of attenuation.

1:35

Maybe with the pseudoaneurysm being larger,

1:38

that's not completely enhancing here, but on your

1:41

search pattern, when you go into hero status,

1:43

which is where you're always trying to make it,

1:45

you want to look for these tiny pseudoaneurysms.

1:48

Unfortunately, they can rupture and cause

1:52

devastating consequences, if not death.

Case: Pancreatitis With Pseudoaneurysm of Splenic Artery

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