Pancreatic pseudomass due to thrombosed pseudoaneurysm

Vivek Halappa, Atif Zaheer

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Imaging description Small nodular hepatic early enhancing areas on multiphasic contrast-enhanced CT or MRI imaging can mimic malignant pathology. These early enhancing lesions are typically located in the periphery of the liver, measure only a few millimeters and are visible predominantly on the arterial phase of contrast imaging fading to isodensity/intensity on the delayed-phase imaging (Figures 74.1 and 74.2). Importantly, these lesions do not have a corresponding abnormality on the non-contrast T1-and T2-weighted MR imaging (Figure 74.3 and 74.4) and do not demonstrate restricted diffusion on diffusion-weighted imaging. Importance An arterioportal shunt occurs as result of a direct connection between the hepatic arterial and the portal venous systems and is an important cause of transient hepatic attenuation/intensity difference (THAD/THID). This tends to occur in the presence of diminished portal venous flow as in the case of cirrhosis or due to external factors such as trauma or percutaneous intervention. These pseudolesions have to be differentiated from malignant ones to avoid unwarranted anxiety in patients and to avoid invasive testing such as biopsy or even surgical resection. Typical clinical scenario These lesions may be a source of concern in patients with cirrhosis or a known malignancy with hypervascular metastasis such as renal cell carcinoma or neuroendocrine tumors. Due to their small size biopsy is usually not an option and these lesions tend to disappear or remain stable on the follow-up examinations (Figure 74.5). Differential diagnosis A small flash-filling hemangioma is typically very bright on T2-weighted MR imaging and typically retains contrast on the more delayed-phase imaging. Hepatocellular carcinoma and even metastatic disease from cancers like renal cell, melanoma or neuroendocrine tumors tend to washout on the venous and delayed-phase imaging and appear as lower density/intensity than the liver. The absence of washout on delayed imaging, peripheral location, small size, and absence of abnormality on T1-, T2-and diffusion-weighted imaging along with long-term stability are features of a benign process such as an arterioportal shunt.

Original languageEnglish (US)
Title of host publicationPearls and Pitfalls in Cardiovascular Imaging: Pseudolesions, Artifacts and Other Difficult Diagnoses
PublisherCambridge University Press
Pages239-240
Number of pages2
ISBN (Print)9781139152228, 9781107023727
DOIs
StatePublished - Jan 1 2015

Fingerprint

False Aneurysm
Thrombosis
Liver
Neuroendocrine Tumors
Renal Cell Carcinoma
Fibrosis
Portal System
Biopsy
Hemangioma
Hepatocellular Carcinoma
Melanoma
Differential Diagnosis
Anxiety
Pathology
Neoplasm Metastasis
Wounds and Injuries
Neoplasms

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Halappa, V., & Zaheer, A. (2015). Pancreatic pseudomass due to thrombosed pseudoaneurysm. In Pearls and Pitfalls in Cardiovascular Imaging: Pseudolesions, Artifacts and Other Difficult Diagnoses (pp. 239-240). Cambridge University Press. https://doi.org/10.1017/CBO9781139152228.076

Pancreatic pseudomass due to thrombosed pseudoaneurysm. / Halappa, Vivek; Zaheer, Atif.

Pearls and Pitfalls in Cardiovascular Imaging: Pseudolesions, Artifacts and Other Difficult Diagnoses. Cambridge University Press, 2015. p. 239-240.

Research output: Chapter in Book/Report/Conference proceedingChapter

Halappa, V & Zaheer, A 2015, Pancreatic pseudomass due to thrombosed pseudoaneurysm. in Pearls and Pitfalls in Cardiovascular Imaging: Pseudolesions, Artifacts and Other Difficult Diagnoses. Cambridge University Press, pp. 239-240. https://doi.org/10.1017/CBO9781139152228.076
Halappa V, Zaheer A. Pancreatic pseudomass due to thrombosed pseudoaneurysm. In Pearls and Pitfalls in Cardiovascular Imaging: Pseudolesions, Artifacts and Other Difficult Diagnoses. Cambridge University Press. 2015. p. 239-240 https://doi.org/10.1017/CBO9781139152228.076
Halappa, Vivek ; Zaheer, Atif. / Pancreatic pseudomass due to thrombosed pseudoaneurysm. Pearls and Pitfalls in Cardiovascular Imaging: Pseudolesions, Artifacts and Other Difficult Diagnoses. Cambridge University Press, 2015. pp. 239-240
@inbook{bf33277bd4cc4146935b658818675b82,
title = "Pancreatic pseudomass due to thrombosed pseudoaneurysm",
abstract = "Imaging description Small nodular hepatic early enhancing areas on multiphasic contrast-enhanced CT or MRI imaging can mimic malignant pathology. These early enhancing lesions are typically located in the periphery of the liver, measure only a few millimeters and are visible predominantly on the arterial phase of contrast imaging fading to isodensity/intensity on the delayed-phase imaging (Figures 74.1 and 74.2). Importantly, these lesions do not have a corresponding abnormality on the non-contrast T1-and T2-weighted MR imaging (Figure 74.3 and 74.4) and do not demonstrate restricted diffusion on diffusion-weighted imaging. Importance An arterioportal shunt occurs as result of a direct connection between the hepatic arterial and the portal venous systems and is an important cause of transient hepatic attenuation/intensity difference (THAD/THID). This tends to occur in the presence of diminished portal venous flow as in the case of cirrhosis or due to external factors such as trauma or percutaneous intervention. These pseudolesions have to be differentiated from malignant ones to avoid unwarranted anxiety in patients and to avoid invasive testing such as biopsy or even surgical resection. Typical clinical scenario These lesions may be a source of concern in patients with cirrhosis or a known malignancy with hypervascular metastasis such as renal cell carcinoma or neuroendocrine tumors. Due to their small size biopsy is usually not an option and these lesions tend to disappear or remain stable on the follow-up examinations (Figure 74.5). Differential diagnosis A small flash-filling hemangioma is typically very bright on T2-weighted MR imaging and typically retains contrast on the more delayed-phase imaging. Hepatocellular carcinoma and even metastatic disease from cancers like renal cell, melanoma or neuroendocrine tumors tend to washout on the venous and delayed-phase imaging and appear as lower density/intensity than the liver. The absence of washout on delayed imaging, peripheral location, small size, and absence of abnormality on T1-, T2-and diffusion-weighted imaging along with long-term stability are features of a benign process such as an arterioportal shunt.",
author = "Vivek Halappa and Atif Zaheer",
year = "2015",
month = "1",
day = "1",
doi = "10.1017/CBO9781139152228.076",
language = "English (US)",
isbn = "9781139152228",
pages = "239--240",
booktitle = "Pearls and Pitfalls in Cardiovascular Imaging: Pseudolesions, Artifacts and Other Difficult Diagnoses",
publisher = "Cambridge University Press",

}

TY - CHAP

T1 - Pancreatic pseudomass due to thrombosed pseudoaneurysm

AU - Halappa, Vivek

AU - Zaheer, Atif

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Imaging description Small nodular hepatic early enhancing areas on multiphasic contrast-enhanced CT or MRI imaging can mimic malignant pathology. These early enhancing lesions are typically located in the periphery of the liver, measure only a few millimeters and are visible predominantly on the arterial phase of contrast imaging fading to isodensity/intensity on the delayed-phase imaging (Figures 74.1 and 74.2). Importantly, these lesions do not have a corresponding abnormality on the non-contrast T1-and T2-weighted MR imaging (Figure 74.3 and 74.4) and do not demonstrate restricted diffusion on diffusion-weighted imaging. Importance An arterioportal shunt occurs as result of a direct connection between the hepatic arterial and the portal venous systems and is an important cause of transient hepatic attenuation/intensity difference (THAD/THID). This tends to occur in the presence of diminished portal venous flow as in the case of cirrhosis or due to external factors such as trauma or percutaneous intervention. These pseudolesions have to be differentiated from malignant ones to avoid unwarranted anxiety in patients and to avoid invasive testing such as biopsy or even surgical resection. Typical clinical scenario These lesions may be a source of concern in patients with cirrhosis or a known malignancy with hypervascular metastasis such as renal cell carcinoma or neuroendocrine tumors. Due to their small size biopsy is usually not an option and these lesions tend to disappear or remain stable on the follow-up examinations (Figure 74.5). Differential diagnosis A small flash-filling hemangioma is typically very bright on T2-weighted MR imaging and typically retains contrast on the more delayed-phase imaging. Hepatocellular carcinoma and even metastatic disease from cancers like renal cell, melanoma or neuroendocrine tumors tend to washout on the venous and delayed-phase imaging and appear as lower density/intensity than the liver. The absence of washout on delayed imaging, peripheral location, small size, and absence of abnormality on T1-, T2-and diffusion-weighted imaging along with long-term stability are features of a benign process such as an arterioportal shunt.

AB - Imaging description Small nodular hepatic early enhancing areas on multiphasic contrast-enhanced CT or MRI imaging can mimic malignant pathology. These early enhancing lesions are typically located in the periphery of the liver, measure only a few millimeters and are visible predominantly on the arterial phase of contrast imaging fading to isodensity/intensity on the delayed-phase imaging (Figures 74.1 and 74.2). Importantly, these lesions do not have a corresponding abnormality on the non-contrast T1-and T2-weighted MR imaging (Figure 74.3 and 74.4) and do not demonstrate restricted diffusion on diffusion-weighted imaging. Importance An arterioportal shunt occurs as result of a direct connection between the hepatic arterial and the portal venous systems and is an important cause of transient hepatic attenuation/intensity difference (THAD/THID). This tends to occur in the presence of diminished portal venous flow as in the case of cirrhosis or due to external factors such as trauma or percutaneous intervention. These pseudolesions have to be differentiated from malignant ones to avoid unwarranted anxiety in patients and to avoid invasive testing such as biopsy or even surgical resection. Typical clinical scenario These lesions may be a source of concern in patients with cirrhosis or a known malignancy with hypervascular metastasis such as renal cell carcinoma or neuroendocrine tumors. Due to their small size biopsy is usually not an option and these lesions tend to disappear or remain stable on the follow-up examinations (Figure 74.5). Differential diagnosis A small flash-filling hemangioma is typically very bright on T2-weighted MR imaging and typically retains contrast on the more delayed-phase imaging. Hepatocellular carcinoma and even metastatic disease from cancers like renal cell, melanoma or neuroendocrine tumors tend to washout on the venous and delayed-phase imaging and appear as lower density/intensity than the liver. The absence of washout on delayed imaging, peripheral location, small size, and absence of abnormality on T1-, T2-and diffusion-weighted imaging along with long-term stability are features of a benign process such as an arterioportal shunt.

UR - http://www.scopus.com/inward/record.url?scp=84954094120&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84954094120&partnerID=8YFLogxK

U2 - 10.1017/CBO9781139152228.076

DO - 10.1017/CBO9781139152228.076

M3 - Chapter

AN - SCOPUS:84954094120

SN - 9781139152228

SN - 9781107023727

SP - 239

EP - 240

BT - Pearls and Pitfalls in Cardiovascular Imaging: Pseudolesions, Artifacts and Other Difficult Diagnoses

PB - Cambridge University Press

ER -