A recent case report published on May 14, 2010 in World Journal of Gastroenterology describes the imaging features of a ruptured superior mesenteric artery aneurysm,which created a giant hematoma and mimicked a pancreatic mass, with mild dilatation of main pancreatic duct.
Previous studies have shown how pancreatic disease can be simulated by various anatomical structures in the retroperitoneal region at the pancreatic level. Aneurysm of the hepatic artery, for example, simulates pancreatic disease, even with the possibility of choledocus compression. In the case, mild compression of the main pancreatic duct by the aneurysm sac could also explain the minimally increased values of amylase and lipase activity discovered through laboratory tests, which initially physicians interpreted as symptoms of pancreatic disease.
The radiologist who first described multidetector computed tomography and magnetic resonance imaging signs did not explore the vascular structures with multiplanar reconstructions, and hypothesized aneurysm not as a primary diagnosis, but as a consequence of a giant mass in the pancreatic tissue. Pre-angiographic evaluation of multiplanar reconstruction, performed with other colleagues, finally oriented him towards diagnosing a giant aneurysm ruptured into the uncinate process.
Significant advancements in 3D and multiplanar imaging software have made it possible to obtain high-resolution images of the abdominal aorta and its branches: radiologists need to keep in mind the diagnostic value of multiplanar reconstructions. In some cases pancreatic masses, for example, pseudocysts, on unenhanced CT scans and MRI have the same density or intensity signals as aneurysms. Contrast administration helps radiologists to reach the correct diagnosis.
Reference: Palmucci S, Mauro LA, Milone P, Di Stefano F, Scolaro A, Di Cataldo A, Ettorre GC. Diagnosis of ruptured superior mesenteric artery aneurysm mimicking a pancreatic mass. World J Gastroenterol 2010; 16(18): 2298-2301 http://www.
Correspondence to: Stefano Palmucci, MD, Department DOGIRA, Section of Radiological Sciences, "Policlinico - Vittorio Emanuele" University Hospital, Via Santa Sofia 78, 95123 Catania, Italy. firstname.lastname@example.org Telephone: +39-95-3782360 Fax: +39-95-3782360
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World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H pylori infection and provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2008 IF: 2.081. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th day of every month. WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the name of China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.
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