case_images: PMC7193146_01
case_images: A 20-year-old gentleman diagnosed as acute pancreatitis presented with hypovolemic shock and fall in hemoglobin. Computed tomography angiogram: (a) Axial, (b) coronal, and (c) volume rendered tomography images. A large pseudo aneurysm (*) is seen arising from the left adrenal artery (white arrow). Offending artery is seen arising as a left anterolateral branch of abdominal aorta (black arrowhead in c), just superolateral to coeliac trunk (black arrow in c).
case_images: JCIS-10-20-g001.jpg
case_images: PMC7193146_01_JCIS-10-20-g001.jpg
case_images: F1
case_images: Marlborough, USA) with automated exposure control. CTA revealed a PSA of approximate size 6 mmx4.4 mm [Figure 1] at left supra renal region with surrounding hematoma and peripancreatic necrotic collections. Maximum intensity projection and volume rendered tomography images demonstrated a PSA arising from the left middle adrenal artery [Figure 1], as a direct branch of the aorta from the left anterolateral aspect.
case_images: A 20-year-old gentleman diagnosed as acute pancreatitis presented with hypovolemic shock and fall in hemoglobin. (a) Digital subtraction angiography shows the pseudoaneurysm (black arrow in a) arising from the left middle adrenal artery. Cannulation was done with RDC catheter (white arrow in a) with coaxially introduced micro catheter (curved arrow in a). (b) Shows a fluoroscopic spot image obtained after trans catheter N-butyl cyanoacrylate: lipiodol (1:3) embolization which shows glue cast in the left middle adrenal artery (black arrow in b).
case_images: JCIS-10-20-g002.jpg
case_images: PMC7193146_01_JCIS-10-20-g002.jpg
case_images: F2
case_images: Post embolization showed a column of embolic agent completely obliterating the lumens of the left middle adrenal artery and left inferior phrenic artery [Figure 2].
case_images: PMC7193146_02
case_images: A 50-year-old gentleman with a diagnosis of unclassified vasculitis presented in shock with a fall in hemoglobin. Coronal maximum intensity project (a) and axial contrast-enhanced computed tomography (CT) angiography (b) shows a small pseudo aneurysm (*) at left supra renal region arising from left middle adrenal artery (white arrow) (c) shows direct puncture of the aneurysm sac under CT guidance with the help of a Chiba needle (black arrow). (d) Axial CT angiographic study performed after embolization with N-butyl cyanoacrylate shows glue cast (white arrow) with the absence of filling of the pseudo aneurysm sac.
case_images: JCIS-10-20-g003.jpg
case_images: PMC7193146_02_JCIS-10-20-g003.jpg
case_images: F3
case_images: A CTA was done (scanning parameters as case 1), which showed a left middle adrenal artery PSA of size 7.3 mm with a large surrounding hematoma [Figures 3a and 3b]. The position of tip within the aneurysmal sac was established once the free flow of blood was obtained in the trocar, further confirmed on low dose limited CT cuts [Figure 3c]. Technical success of embolization was confirmed by immediate post-procedure CT angiography which showed the absence of filling of PSA [Figure 3d].