Ruptured gastric artery aneurysms: two cases and emergency imaging findings.

Simon Mcqueen,Elizabeth Dick,John Vedelago,Mark Page,John Velkovic

doi:10.1259/bjrcr.20170075

Abstract

A ruptured gastric artery aneurysm is a rare but important possible cause of massive intra-abdominal or gastrointestinal haemorrhage, and carries a high risk of mortality. Although aneurysms of the gastric arteries are uncommon, emergency radiologists and clinicians should be familiar with the clinical presentation, imaging findings and pathophysiology. We present two cases of massive intra-abdominal haemorrhage and haemodynamic shock secondary to acute rupture of previously occult gastric artery aneurysm and review the relevant anatomy, imaging findings and pathophysiology of gastric and other visceral artery aneurysms. By virtue of its location in the lesser omentum, a ruptured gastric artery aneurysm may result in a typical pattern and distribution of adjacent haematoma in the upper abdomen. Our description of imaging findings highlights a characteristic epicentre of intraperitoneal haemorrhage, and its typical mass effect displacement of surrounding viscera, to aid the emergent diagnosis of gastric artery aneurysm rupture.

Highlights

Urgent portal venous phase abdominal CT was performed
DISCUSSION gastric artery aneurysm rupture as a presentation is uncommon as gastric artery aneurysms account for just 4% of all visceral artery aneurysms,[1] rupture is associated with a high mortality rate.[2]
Noting that there is a considerable degree of anatomic variation of the coeliac axis and its branches, in conventional anatomic description the coeliac axis divides at the upper border of the pancreas into the left gastric artery, and bifurcates to form the common hepatic and splenic arteries

Summary

Introduction

There was no known history of visceral or other arterial aneurysm, pancreatitis or connective tissue disease and the patient was otherwise fit and well. The anteroposterior scout image showed a large epigastric density displacing the lesser curvature of the stomach inferiorly (Figure 1 white arrow). Images showed extremely rapid extravasation of contrast from a ruptured bilobed 18 mm left gastric artery aneurysm (Figure 1 black arrow).

Results

Conclusion