28353569 Visualization

A 41 Age - year Age - old Age man Sex with a history of alcoholism History for 10 Duration years Duration and sober History for the last Duration 3 Duration years Duration , recurrent History alcoholic History pancreatitis History , and no History known History liver History disease History , presented Clinical_event with several Detailed_description episodes Detailed_description of hematemesis Sign_symptom and abdominal Biological_structure pain Sign_symptom for 2 Duration days Duration .
Esophagogastroduodenoscopy Diagnostic_procedure ( EGD Diagnostic_procedure ), performed 3 Date years Date earlier Date for abdominal Biological_structure pain Sign_symptom , had revealed no esophageal Biological_structure varices Sign_symptom , gastric Biological_structure varices Sign_symptom , portal Biological_structure hypertensive Detailed_description gastropathy Disease_disorder , or other GI Biological_structure lesions Sign_symptom .
Physical Diagnostic_procedure examination Diagnostic_procedure revealed a blood Diagnostic_procedure pressure Diagnostic_procedure  =  100/60 Lab_value   mm Lab_value   Hg Lab_value , pulse Diagnostic_procedure  =  60 Lab_value   beats/min Lab_value , no jaundice Sign_symptom , no stigmata Sign_symptom of Sign_symptom chronic Sign_symptom liver Sign_symptom disease Sign_symptom , a soft Sign_symptom abdomen Biological_structure with mild Severity epigastric Biological_structure tenderness Sign_symptom but no rebound Detailed_description tenderness Sign_symptom , no abdominal Biological_structure bruit Sign_symptom , and no pulsatile Detailed_description abdominal Biological_structure mass Sign_symptom .
Rectal Diagnostic_procedure examination Diagnostic_procedure revealed gross melena Sign_symptom .
Laboratory Diagnostic_procedure tests Diagnostic_procedure revealed hemoglobin Diagnostic_procedure  =  12.5 Lab_value   g/dL Lab_value , platelets Diagnostic_procedure  =  301,000/mL Lab_value , INR Diagnostic_procedure ( international Diagnostic_procedure normalized Diagnostic_procedure ratio Diagnostic_procedure ) =  1.0 Lab_value , blood Diagnostic_procedure urea Diagnostic_procedure nitrogen Diagnostic_procedure  =  20 Lab_value   mg/dL Lab_value , and creatinine Diagnostic_procedure  =  1.1 Lab_value  mg/dL.
Serum Diagnostic_procedure aspartate Diagnostic_procedure aminotransferase Diagnostic_procedure  =  21 Lab_value   IU/L Lab_value , alanine Diagnostic_procedure aminotransferase Diagnostic_procedure  =  16 Lab_value   IU/L Lab_value , total Diagnostic_procedure bilirubin Diagnostic_procedure  =  0.6 Lab_value   mg/dL Lab_value , alkaline Diagnostic_procedure phosphatase Diagnostic_procedure  =  64 Lab_value   IU/L Lab_value , albumin Diagnostic_procedure  =  4.4 Lab_value   gm/dL Lab_value , and lipase Diagnostic_procedure  =  32 Lab_value  U/dL.
The hemoglobin Diagnostic_procedure declined Lab_value acutely Lab_value to 9.3 Lab_value  g/dL.
Abdomino Biological_structure - pelvic Biological_structure computerized Diagnostic_procedure tomography Diagnostic_procedure ( CT Diagnostic_procedure ), with intravenous Detailed_description contrast, Detailed_description revealed a 5 Distance - cm Distance wide, irregular Detailed_description , pancreatic Biological_structure / peripancreatic Biological_structure mass Sign_symptom , compressing Sign_symptom both the lesser Biological_structure curvature Biological_structure of Biological_structure the Biological_structure stomach Biological_structure and the SV Biological_structure (Fig.1A, B), a normal Lab_value portal Diagnostic_procedure vein Diagnostic_procedure , and normal Lab_value liver Diagnostic_procedure parenchyma Diagnostic_procedure .
The SV Biological_structure compression Sign_symptom was pathophysiologically Lab_value significant Lab_value as indicated by proximal Biological_structure SV Biological_structure dilatation Sign_symptom .
EGD Diagnostic_procedure revealed in the proximal Biological_structure stomach Biological_structure a fine Detailed_description , reticular Detailed_description , pale Color - white Color , polygonal Shape , mucosal Biological_structure , network Sign_symptom in a snakeskin Texture pattern Texture , and characteristic of portal Disease_disorder hypertensive Disease_disorder gastropathy Disease_disorder that was actively oozing Sign_symptom ; extensive Severity coffee Texture - ground Texture , blood Sign_symptom clots Sign_symptom in the stomach Biological_structure ; small gastric Biological_structure cardial Biological_structure and fundal Biological_structure varices Sign_symptom without stigmata Sign_symptom of Sign_symptom recent Sign_symptom hemorrhage Sign_symptom ( SRH Sign_symptom ); and no esophageal Biological_structure varices Sign_symptom (Fig.​2).
The extrinsic mass Coreference produced a large Detailed_description , round Shape bulge Sign_symptom extending Biological_structure into Biological_structure the Biological_structure lumen Biological_structure of Biological_structure the Biological_structure proximal Biological_structure gastric Biological_structure body Biological_structure along the lesser Biological_structure curvature Biological_structure (Fig.2).
Magnetic Diagnostic_procedure resonance Diagnostic_procedure cholangio Diagnostic_procedure - pancreatography Diagnostic_procedure ( MRCP Diagnostic_procedure ) revealed a 5 Distance - cm Distance wide, enhancing Detailed_description , vascular Biological_structure mass Sign_symptom likely arising Biological_structure from Biological_structure the Biological_structure LGA Biological_structure and located between Biological_structure the Biological_structure gastric Biological_structure lesser Biological_structure curvature Biological_structure and Biological_structure distal Biological_structure pancreatic Biological_structure body Biological_structure ; compressing Sign_symptom the stomach Biological_structure ; compressing Sign_symptom the middle Biological_structure SV Biological_structure ; and resulting in large Detailed_description collateral Sign_symptom veins Sign_symptom draining the SV Biological_structure into the superior Biological_structure mesenteric Biological_structure vein Biological_structure (Fig.3A, B).
Abdominal Biological_structure ultrasound Diagnostic_procedure with Doppler Detailed_description studies Detailed_description demonstrated large Detailed_description , turbulent Detailed_description arterial Biological_structure flow Sign_symptom into this vascular Biological_structure mass Coreference , suggesting a large Detailed_description PA Disease_disorder (Fig.4).
Visceral Detailed_description arteriogram Diagnostic_procedure showed a 5.3 Volume   × Volume   2.2 Volume - cm Volume - wide Volume PA Disease_disorder supplied by an LGA Biological_structure branch Biological_structure (Fig.5A), which was embolized Therapeutic_procedure and occluded Therapeutic_procedure with microcoils Detailed_description (Fig.5B).
Eight Date weeks Date later Date , the patient had a stable Lab_value hemoglobin Diagnostic_procedure level with no further GI Biological_structure bleeding Sign_symptom .
Abdomino Biological_structure - pelvic Biological_structure CT Detailed_description angiography Diagnostic_procedure demonstrated the PA Disease_disorder had markedly decreased Lab_value in Lab_value diameter Lab_value , contained Detailed_description numerous Detailed_description microcoils Detailed_description , and had no Detailed_description blood Detailed_description flow Detailed_description ​(Fig.1C).