0:00

Okay, so pancreatitis can be complicated

0:03

by splenic artery pseudoaneurysms,

0:05

and they can be extremely small.

0:07

As we just saw, this is just a small nubbin of

0:10

attenuation here coming off of the splenic artery,

0:12

with a larger pseudoaneurysm, which probably

0:14

is not filling on this earlier arterial image.

0:17

Remember, in medicine, the word pseudo is super fun.

0:20

You can put it in front of anything and it just works.

0:22

But the pseudoaneurysm is basically just

0:24

a collection of blood in some space, maybe

0:26

a little adventitia, maybe a little media.

0:28

It's really hard to know.

0:30

When imaged, they will have a little

0:31

neck here and some to-and-fro blood

0:34

flow within the pseudoaneurysm itself.

0:37

If you can imagine this on ultrasound,

0:39

it would usually have that classic—

0:43

going towards the transducer and away from the

0:45

transducer in a circular motion coming in and out of

0:48

blood pool without frank extravasation of contrast.

0:52

We usually call that the yin-yang sign.

0:54

So always look for these small pseudoaneurysms.

0:56

They are a harbinger for bad

0:58

things to happen in the future.

1:00

They will, um, blow up and cause excessive bleeding

1:03

and hemorrhagic conversion of your pancreatitis.

1:06

And because it's arterial, um, they really need to be

1:09

coiled as quickly as possible, and this patient

1:11

went on for interventional coiling because our

1:13

resident made this call in the middle of the night.

1:16

This patient did very well, and

1:17

that was, right, a ticking time bomb.

1:19

So if you can make the calls of the portal

1:21

vein thrombosis and these small splenic

1:23

pseudoaneurysms, you've hit next level and

1:26

you are ready to fly at night on your own.

Pancreatitis Complication: Splenic Artery Pseudoaneurysm

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