Investig Magn Reson Imaging.  2015 Dec;19(4):241-247. 10.13104/imri.2015.19.4.241.

Pancreatic Arteriovenous Malformation as an Unusual Cause of Chronic Gastrointestinal Bleeding in a Patient with Early Gastric Cancer: Multimodality Imaging Spectrum with Pathologic Correlation

• Lee B
• Lee JE
• Cho JS
• Shin KS
• You SK
• Cheon KS
• Song IS
• Kim KH

• KMID: 2151772
• DOI: http://doi.org/10.13104/imri.2015.19.4.241

Abstract

Arteriovenous malformation (AVM) of the pancreas is extremely rare, although it may be increasingly diagnosed due to the widespread use of cross-sectional imaging of the abdomen. Early diagnosis of this disease is important to prevent delay of treatment and resulting fatal complications. We report a rare case of pancreatic AVM in a 48-year-old man who presented with severe chronic anemia and early gastric cancer, which made diagnosis challenging. Imaging findings, including ultrasound, computed tomography, and magnetic resonance imaging, are shown, as well as the pathologic features.

Keyword

Arteriovenous malformations; Pancreas; Pancreaticoduodenectomy; Magnetic resonance imaging; Tomography; X-Ray Computed; Ultrasound

MeSH Terms

Abdomen
Anemia
Arteriovenous Malformations*
Diagnosis
Early Diagnosis
Hemorrhage*
Humans
Magnetic Resonance Imaging
Middle Aged
Pancreas
Pancreaticoduodenectomy
Stomach Neoplasms*
Ultrasonography

Figure

• 

  Fig. 1 Pancreatic arteriovenous malformation in a 41-year-old man, CT findings. (a) Axial scan, during the arterial phase, shows an irregularly tangled hypervascular lesion in the pancreatic head. (b) In the delayed phase, the lesion is difficult to define because of isodense enhancement relative to normal pancreatic parenchyma.

• 

  Fig. 2 Pancreatic arteriovenous malformation in a 41-year-old man, MRI findings. (a, b) T2-weighted imaging shows the characteristic clustered tubular signal void (arrows). (c-e) Axial scan during the arterial phase of dynamic T1-weighted imaging shows an irregularly tangled hypervascular lesion in the pancreatic head (c) and early enhancement of the dilated portal vein (d) and pancreaticoduodenal vein (arrow) that drained into the dilated portal vein (e).

• 

  Fig. 3 Pancreatic arteriovenous malformation in a 41-year-old man, US findings. (a) A gray-scale ultrasonogram demonstrates an ill-marginated anechoic lesion (arrows) around the head of the pancreas. (b) On color Doppler ultrasonogram shows mosaic color flow pattern with large amount of color signals around the pancreas. (c) Spectral Doppler ultrasonogram of the main portal vein reveals pulsatile pattern, suggesting the draining role of the portal vein.

• 

  Fig. 4 Pancreatic arteriovenous malformation in a 41-year-old man, gross and microscopic findings. (a) A cut section of the pancreas shows multiple honeycomb-like dilated spaces. (b, c) Histopathologic examination of the resected pancreas reveals irregularly dilated angiodysplastic vessels in the pancreas (× 40, H&E staining) (b) and thick-walled artery and thin-walled vein connections with irregular duplication (arrows) (× 100, elastin staining) (c).

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