A case of chronic pancreatitis in which endoscopic ultrasonography was effective in the diagnosis of a pseudoaneurysm

Figure 1 Abdominal computed tomographic findings. A severely atrophied pancreas with a calcified body was noted. The pseudocyst (arrow) ranged from the back of the pancreas to the left mediastinum and was adjacent to the splenic artery.

Figure 2 Endoscopic retrograde pancreatography findings. A: Endoscopic retrograde pancreatography showed stenosis of the principal pancreatic duct at the pancreatic head (dotted arrow) and a dilated tail duct communicating with the left mediastinal pseudocyst (solid arrows).

Figure 3 Upper gastrointestinal endoscopy findings. Upper gastrointestinal endoscopy showed a 2 cm, submucosal tumor-like protrusion with a red, eroded upper region located in the lesser curvature of the middle of the body of the stomach (arrow).

Figure 4 Endoscopic ultrasonography findings. A1: Endoscopic ultrasonography showed an anechoic region whose entire periphery was hypoechoic beneath the gastric mucosa. Power Doppler showed blood flow in the anechoic region. Upper gastrointestinal endoscopy showed a 2 cm, submucosal tumor-like protrusion with a red, eroded upper region located in the lesser curvature of middle of the body of the stomach (arrow); A2: Pulsed wave Doppler showed pulsatile blood flow in the anechoic region. This finding led to the diagnosis of an aneurysm; B: The cessation of blood flow to the pseudoaneurysm was confirmed with endoscopic ultrasonography which was performed 1 wk after treatment (arrow).

Figure 5 Angiography findings. A1: The pseudoaneurysm of the left gastric artery was diagnosed on angiography (arrow). The left hepatic artery diverged from the left gastric artery; A2: The microcatheter was advanced in the region of the pseudoaneurysm, and the pseudoaneurysm was embolized with histoacryl and lipiodol; B: A small pseudoaneurysm was observed in the splenic artery (arrow), and the splenic artery was embolized by coils.