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Visceral and Peripheral Arterial Pseudoaneurysms

¹ Department of Radiology, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
² Department of Radiology, Nagasaki Municipal Hospital, 6-39 Shinchi-machi, Nagasaki 850-0842, Japan.

View larger version (84K): [in a new window]   Fig. 1A —53-year-old man with pseudoaneurysms in aorta after surgery for thoracic aortic aneurysm. Two years after surgery, contrast-enhanced CT images of thoracic aorta show pseudoaneurysms (arrows) at both anastomotic sites of graft.

View larger version (97K): [in a new window]   Fig. 1B —53-year-old man with pseudoaneurysms in aorta after surgery for thoracic aortic aneurysm. Two years after surgery, contrast-enhanced CT images of thoracic aorta show pseudoaneurysms (arrows) at both anastomotic sites of graft.

View larger version (117K): [in a new window]   Fig. 1C —53-year-old man with pseudoaneurysms in aorta after surgery for thoracic aortic aneurysm. Surgery was performed again. Photomicrograph of specimen of pseudoaneurysm of aorta shows that its wall consists of thrombus (a) and reactive fibrosis (b). There is no native wall structure. (H and E, x 40)

View larger version (166K): [in a new window]   Fig. 2A —68-year-old man with pseudoaneurysm of heart due to infarction. Axial spin-echo (A) and cine (B) MR images show pseudoaneurysm (arrows) of left ventricle due to myocardial infarction of posterolateral wall.

View larger version (171K): [in a new window]   Fig. 2B —68-year-old man with pseudoaneurysm of heart due to infarction. Axial spin-echo (A) and cine (B) MR images show pseudoaneurysm (arrows) of left ventricle due to myocardial infarction of posterolateral wall.

View larger version (170K): [in a new window]   Fig. 2C —68-year-old man with pseudoaneurysm of heart due to infarction. Photograph of intraoperative findings reveals myocardial defect (arrow) covered by pericardium (arrowheads). In this case, patch graft for myocardial defect was performed.

View larger version (125K): [in a new window]   Fig. 3 —55-year-old man with pseudoaneurysm caused by angiographic procedure (coronary artery angiography). Contrast-enhanced axial CT image shows pseudoaneurysm of right femoral artery (arrows) after angiography. Recently, pseudoaneurysm of femoral artery tends to be treated by interventional techniques such as compression therapies, thrombin injection, or both. However, surgery was selected in this case because of severe pain.

View larger version (135K): [in a new window]   Fig. 4A —65-year-old man with pseudoaneurysm caused by chemoembolization for multiple hepatocellular carcinomas. Two weeks after chemoembolization, unenhanced CT image shows multiple areas of iodized oil (Lipiodol, Guerbet) in tumors.

View larger version (164K): [in a new window]   Fig. 4B —65-year-old man with pseudoaneurysm caused by chemoembolization for multiple hepatocellular carcinomas. Three months after A, angiogram was obtained because recurrent tumors were suspected. Angiogram shows tiny pseudoaneurysms of hepatic arteries (arrows). These pseudoaneurysms were not detectable on CT (not shown). Chemoembolization damaged vessel wall.

View larger version (167K): [in a new window]   Fig. 5A —24-year-old man with splenic pseudoaneurysm caused by blunt abdominal trauma due to motor vehicle crash. Contrast-enhanced CT image shows pseudoaneurysm in spleen (arrow).

View larger version (156K): [in a new window]   Fig. 5B —24-year-old man with splenic pseudoaneurysm caused by blunt abdominal trauma due to motor vehicle crash. Splenic angiogram shows pseudoaneurysm in spleen (arrow). Metallic coil embolization was performed.

View larger version (67K): [in a new window]   Fig. 6A —84-year-old woman with mesenteric pseudoaneurysm caused by blunt abdominal trauma due to motor vehicle crash. Contrast-enhanced CT image shows pseudoaneurysm (arrow) and hematoma in mesenterium.

View larger version (159K): [in a new window]   Fig. 6B —84-year-old woman with mesenteric pseudoaneurysm caused by blunt abdominal trauma due to motor vehicle crash. Angiogram of superior mesenteric artery shows pseudoaneurysm (arrows). Pseudoaneurysm is relatively rare in mesenterium.

View larger version (80K): [in a new window]   Fig. 7A —19-year-old man with thoracic aortic pseudoaneurysm caused by blunt trauma due to motor vehicle crash. Contrast-enhanced CT image shows pseudoaneurysm in aortic arch (arrow).

View larger version (151K): [in a new window]   Fig. 7B —19-year-old man with thoracic aortic pseudoaneurysm caused by blunt trauma due to motor vehicle crash. Thoracic aortogram shows pseudoaneurysm in region of aortic isthmus (arrow). This case is typical of thoracic aortic pseudoaneurysm caused by trauma. Surgery was performed. After surgery, patient has been doing well.

View larger version (104K): [in a new window]   Fig. 8A —44-year-old man with pseudoaneurysm caused by neurofibromatosis. Contrast-enhanced CT image shows large masses (neurofibromas) around sacrum and left buttock. Hematomas (arrows) are seen around tumor, but pseudoaneurysm is not detectable on CT.

View larger version (149K): [in a new window]   Fig. 8B —44-year-old man with pseudoaneurysm caused by neurofibromatosis. Angiogram of left internal iliac artery shows pseudoaneurysm (arrow) originating from left superior gluteal artery.

View larger version (116K): [in a new window]   Fig. 9A —35-year-old man with pseudoaneurysm caused by malignant lymphoma. Unenhanced CT image shows marked hepatosplenomegaly. After CT examination, chemotherapy started.

View larger version (126K): [in a new window]   Fig. 9B —35-year-old man with pseudoaneurysm caused by malignant lymphoma. Seven days after A, patient complained of severe abdominal pain. Unenhanced CT image shows spleen has rapidly decreased in size, and hematoma (arrows) is seen in spleen.

View larger version (121K): [in a new window]   Fig. 9C —35-year-old man with pseudoaneurysm caused by malignant lymphoma. Splenic angiogram shows pseudoaneurysm (arrow). This pseudoaneurysm is caused by erosion by lymphoma.

View larger version (151K): [in a new window]   Fig. 9D —35-year-old man with pseudoaneurysm caused by malignant lymphoma. Splenectomy was performed. Photomicrograph of specimen of spleen shows that lymphoma cells (arrows) invade arterial wall (arrowheads). This is not a site of pseudoaneurysm. (H and E, x 10)

View larger version (148K): [in a new window]   Fig. 10A —56-year-old man with pseudoaneurysm caused by Salmonella infection in abdominal aorta. Contrast-enhanced CT image shows pseudoaneurysm (arrow) and abscess (arrowheads) around aorta.

View larger version (158K): [in a new window]   Fig. 10B —56-year-old man with pseudoaneurysm caused by Salmonella infection in abdominal aorta. Aortogram shows pseudoaneurysm (arrow). Usually, surgery is first choice of treatment for infected aneurysm. In this case, stent-graft placement was selected because this patient was a poor surgical candidate. Although patient was placed on antibiotics during and after this procedure; he died of rupture of pseudoaneurysm.

View larger version (133K): [in a new window]   Fig. 11A —45-year-old man with pseudoaneurysm caused by Behçet's syndrome in pulmonary artery. Chest radiograph shows nodule (arrows) near left hilum.

View larger version (156K): [in a new window]   Fig. 11B —45-year-old man with pseudoaneurysm caused by Behçet's syndrome in pulmonary artery. Pulmonary arteriogram shows pseudoaneurysm of segmental branch of pulmonary artery (arrow). Patient died of rupture of this pseudoaneurysm.

View larger version (172K): [in a new window]   Fig. 12 —34-year-old woman with severe abdominal pain and pseudoaneurysm caused by Takayasu's arteritis. Contrast-enhanced oblique coronal reformatted CT image shows large pseudoaneurysm in abdominal aorta. Although emergency surgery was planned, this patient died of rupture of pseudoaneurysm.

View larger version (125K): [in a new window]   Fig. 13A —64-year-old man with pseudoaneurysm caused by pancreatitis. Contrast-enhanced axial CT image shows large pseudoaneurysm.

View larger version (108K): [in a new window]   Fig. 13B —64-year-old man with pseudoaneurysm caused by pancreatitis. Splenic angiogram shows pseudoaneurysm originating from splenic artery.

View larger version (93K): [in a new window]   Fig. 14A —82-year-old woman with chest pain and pseudoaneurysm caused by penetrating atherosclerotic ulcer. Contrast-enhanced axial CT image (A) and coronal reformatted image (B) show large pseudoaneurysm in descending thoracic aorta (arrow). In this case, penetrating atherosclerotic ulcer may be cause of pseudoaneurysm. Surgery was performed. After undergoing surgery, patient has been doing well.

View larger version (139K): [in a new window]   Fig. 14B —82-year-old woman with chest pain and pseudoaneurysm caused by penetrating atherosclerotic ulcer. Contrast-enhanced axial CT image (A) and coronal reformatted image (B) show large pseudoaneurysm in descending thoracic aorta (arrow). In this case, penetrating atherosclerotic ulcer may be cause of pseudoaneurysm. Surgery was performed. After undergoing surgery, patient has been doing well.

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