Pseudoaneurysm of Splenic Artery - A Severe Vascular Complication of Pancreatitis

Acute pancreatitis is one of the common abdominal pathologies having an incidence of 10 to 100 cases per 100,000 population worldwide with varying type of presentation ranging from self-limiting abdominal pain to high mortality and morbidity due to organ failure. The major risk factors leading to pancreatitis include gall stones and alcohol consumption, others being trauma, drugs, and infections.1,2 The revised Atlanta classification (2012) has classified acute pancreatitis on the basis of local, systemic complications and organ failure as mild, moderately severe and severe type of pancreatitis. One of the dreaded local complications of pancreatitis are the vascular complications occurring with a frequency of 1.2 - 14 %, with a greater incidence seen in chronic pancreatitis (7 - 10 %) than acute pancreatitis (1 - 6 %). The two main types of vascular complications being splenic vein thrombosis (more common) and pseudo aneurysm of (in order of decreasing frequency) the splenic, gastro duodenal, and pancreaticoduodenal arteries.3,4 The common symptoms of pseudoaneurysm of splenic artery are abdominal pain, hematemesis, melena, flank pain, and chest pain. Haemorrhage from pseudo aneurysm can be found in the pseudo cyst, stomach, pancreatic duct, peritoneal cavity, or retro peritoneum making the patient highly haemodynamically unstable at presentation having high rates of morbidity and mortality.5 The mortality rate due to haemorrhages directly related to the pancreas is up to 50 %.2 Clinical diagnosis in these patients is highly difficult due to varied range of symptoms and hence ultrasound coupled with contrast enhanced CT imaging helps in accurate diagnosing of such an entity.Pancreatitis is one of the common abdominal pathologies having variable type of presentation. Vascular complications are rare, but severe in nature having high mortality and morbidity rates. Ultrasound coupled with computer tomography helps in fast and accurate diagnosis of these vascular complications like pseudo aneurysms, aneurysms and thrombosis of peri pancreatic arteries. We are presenting a case report of pseudoaneurysm of splenic artery.

Autosomal Dominant Polycystic Kidney Disease with Liver and Pancreatic Involvement.

Autosomal dominant polycystic kidney disease (adult polycystic kidney disease, Potter Type III disease) is the fourth-most common cause of end-stage renal disease.(1) Polycystic Liver Disease, the most common extrarenal manifestations of Polycystic Kidney Disease is seen in 75-90% of cases, characterized by multiple biliary cystic lesions localized in over 50% of the hepatic parenchyma. In Polycystic kidney disease, hepatic cysts develop later than the renal cysts.(2) It is associated with hypertension in about 70% of cases, cyst in pancreas in 9%, saccular berry aneurysm of cerebral arteries in 3-13%, and mitral valve prolapse.

Ultrasound Evaluation of Uterine Leiomyoma in Perimenopausal Females with Histopathological Correlation.

Abnormal uterine bleeding remains an important health issue in perimenopausal females, often a cause of high morbidity and mortality. Uterine leiomyoma is the major cause of abnormal or irregular bleeding. We wanted to evaluate the role of ultrasound in assessing uterine leiomyomas and determine its sensitivity, specificity and diagnostic accuracy in comparison to histopathological studies.METHODSThis is a cross sectional, observational and analytical study conducted in the Department of Radiodiagnosis at AVBRH, (Sawangi Meghe), a rural tertiary care hospital in central India. The study was carried out over a period of 6 months from January 2019 to June 2019. 50 patients in perimenopausal age group of 40-50 years were selected on the basis of predetermined inclusion and exclusion criteria. All included patients were counselled and asked for informed consent before entry into the study. Statistical analysis was done using descriptive and inferential statistics using sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy.RESULTSMost of the uterine leiomyomas were intramural in location and hypoechoic in echotexture. Intramural fibroid was the most common fibroid detected constituting 88%. The sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], and diagnostic accuracy of ultrasound in correlation to histopathology was found to be 93.75%, 91.67%, 97.83%, 78.57% and 93.33% respectively.CONCLUSIONSUltrasound has high sensitivity and specificity in diagnosing the uterine leiomyomas. It should be used as primary investigative modality for work up of abnormal uterine bleeding in perimenopausal age group