Abstract
A-65-year-old female was brought to the emergency room (ER) with abdominal pain, and was diagnosed with contrast - enhanced CT scan as having a ruptured anterior superior pancreaticoduodenal aneurysm including multiple abdominal visceral aneurysms. Successful emergency transcatheter arterial embolization (TAE) stabilized the patient's hemodynamic state. However, follow-up CT scans showed new dilatation of the posterior superior pancreaticoduodenal artery (PSPDA) soon after TAE, and she underwent a second angiography on the 11th hospital day to treat the progressive dilatation of the aneurysm. The second interventional radiology (IVR) resolved the two pseudoaneurysms of the PSPDA that were not recognized in the first angiography. There were no new aneurysms or any indication of dilatation of the preceding aneurysms, and therefore she was transferred to another hospital on the 22th day. She was clinically diagnosed as having segmental arterial mediolysis (SAM) because of the multiple abdominal visceral aneurysms; there are no clinical reports of aneurysmal formation over several days associated with SAM as in this case. Although the definitive diagnose of SAM is based on a histopathological examination, it is necessary to establish the clinical diagnostic criteria because nonoperative management of such cases is increasing and appropriate intervention is necessary in patients with rapidly progressive arteriopathy.
