CONTRAST-ENHANCED ULRASONOGRAPHY IN DIAGNOSIS AND FOLLOW UP OF PANCREATIC PSEUDOANEURYSM – CASE REPORT.

Pancreatic pseudoaneurysm is a rare condition usually associated with pancreatic disorders: pancreatitis, neoplasm, or cystic lesions of the pancreas. Almost 10% of patients with chronic pancreatitis develop during disease progression a pseudoaneurysm. Usually appears secondary to a communication between a pseudocyst and a nearby artery. We present the case of a patient with chronic pancreatitis, with recurrent exacerbations and pseudocyst of 4 cm diameter located posterior of the pancreatic body. The conventional abdominal ultrasound revealed the hypoechoic mass, suspected at that moment for complicated pseudocyst. Contrast enhanced ultrasound revealed a hypervascular area 1.5 cm diameter inside de cystic lesion, suspected of pseudoaneurysm. The digital arteriography confirms the diagnosis of pseudoaneurysm originated form first branch of superior mesenteric artery (SMA), but without treatment options at that time. EUS confirmed the diagnosis of chronic pancreatitis and pancreatic pseudoaneurysm, no other suspected masses were detected. Two weeks later, the patient presented again in the emergency room for severe abdominal pain, laboratory tests showing an increased serum amylase and lipase level. Ultrasound revealed the same lesion of 5 cm diameter posterior of the body, with color Doppler suggestive of pseudoaneurysm, this time 3 cm in diameter. During hospitalization patient presented upper GI bleeding without any lesion found at upper GI endoscopy. Further emergency arteriography was performed, with coils angioembolization of the lesion, without complications. CT scan and ultrasound performed at one week confirm the successful treatment of pseudoaneurysm. The review of the literature in the field of pancreatic pseudoaneurysm revealed isolated cases reports, few data series. Although the role of CEUS in pancreatic disorders is largely discussed in the literature, in pancreatic pseudoaneurysm, due to the rarity of the cases, is not well standardized. [ABSTRACT FROM AUTHOR]