Pancreaticoduodenal artery aneurysm associated with coeliac artery occlusion from an aortic intramural hematoma

Figure 1 Initial computed tomography performed at local hospital before the onset of hypotension. A: Plain computed tomography (CT) demonstrating dilated descending aorta and hyperattenuated collection located eccentrically within the aortic wall (arrow); B: Contrast-enhanced CT revealed crescentic and asymmetric wall thickening of the descending aorta: Contrast is not visualized within the aortic media. Intimal flap was not detected; C: An aneurysm at the anteroinferior pancreaticoduodenal artery (arrow); D: The occluded root of the coeliac artery (arrow).

Figure 2 Subsequent contrast-enhanced computed tomography and arteriography performed at our hospital, after the onset of hypotension. A: Multidetector computed tomography (CT) performed at our hospital showing the root of the coeliac artery compressed and occluded by the false lumen more clearly than that performed at a local hospital; B: CT scan showing a large haematoma in the right prerenal space (arrow head) and the aneurysm of anteroinferior pancreaticoduodenal artery (arrow); C: Arteriogram of the superior mesenteric artery (SMA) showing blood flow reversal from the SMA to the hepatic artery through the pancreaticoduodenal arcade, due to coeliac trunk occlusion and a saccular aneurysm of the inferior pancreaticoduodenal artery (PDA) (arrow).