KMID : 1048120140030020112
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International Journal of Gastrointestinal Intervention 2014 Volume.3 No. 2 p.112 ~ p.115
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Looking beyond lymph nodes: Beware of the lurking pseudoaneurysm!
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Nasrullah Ayesha
Bell Jon K. Reddy Sailaja Ashleigh Ray Rudralingam Velauthan
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Abstract
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An arteriovenous fistula of the superior mesenteric vessels leading to pseudoaneurysm formation is rare and most commonly occurs after blunt trauma or surgery. We describe a case of a superior mesenteric artery?superior mesenteric vein (SMA/SMV) pseudoaneurysm that was initially misinterpreted as an enlarging hypervascular nodal metastasis on surveillance computed tomography (CT) in a patient who had undergone ileal carcinoid resection. When the case was discussed at the specialist multidisciplinary meeting to consider surgical resection, it was noted that the apparent ¡°hypervascular node¡± on CT had a signal void character on magnetic resonance imaging, which is atypical for a lymph node. Coronal CT reformat demonstrated a vascular origin from the superior mesenteric trunk. This resulted in the correct diagnosis of a pseudoaneurysm secondary to an SMA/SMV fistula. This avoided an unnecessary repeat surgery, and the patient underwent endovascular repair. In our patient, the distal was closed by 3-mm coils and the proximal was closed by an Amplatzer plug with successful results. Hence, it is crucial for radiologists to have a systematic approach and understanding of vascular-related abnormalities to avoid misdiagnosis that can potentially lead to unwanted morbidity.
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KEYWORD
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Carcinoid tumor, Metastasis, Pseudoaneurysm, Superior mesenteric artery, Superior mesenteric vein
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