Electrolyte Blood Press.  2018 Jun;16(1):11-14. 10.5049/EBP.2018.16.1.11.

Esophageal Artery Pseudoaneurysm and Takayasu Arteritis in a Patient with Autosomal Dominant Polycystic Kidney Disease

• Kim H
• Yu Y
• Shim KE
• Kim JE
• Koh J
• Yoon JW
• Ahn C
• Oh YK

• KMID: 2416374
• DOI: http://doi.org/10.5049/EBP.2018.16.1.11

Abstract

A 47-year-old female previously diagnosed with ADPKD visited the hospital due to sudden pain in her upper abdomen and back. Esophagogastroduodenoscopy, contrast-enhanced abdominal computed tomography (CT), and CT angiography identified an esophageal artery pseudoaneurysm and hematoma in the esophagus. Urgent angiography and embolization were performed. After the procedure, CT angiography and positron emission tomography were performed due to differences in blood pressure between the arms. The patient was also found to have Takayasu arteritis and subsequently received outpatient follow-up care. The possible mechanisms that cause vascular abnormalities in ADPKD patients include damaged vascular integrity due to abnormal polycystin expression caused by PKD mutations and connective tissue abnormalities. Further research is needed to confirm these mechanisms, and ADPKD patients should be assessed for vascular abnormalities.

Keyword

Autosomal dominant polycystic kidney disease (ADPKD); Aneurysms; Takayasu arteritis

MeSH Terms

Abdomen
Aneurysm
Aneurysm, False*
Angiography
Arm
Arteries*
Blood Pressure
Connective Tissue
Endoscopy, Digestive System
Esophagus
Female
Follow-Up Studies
Hematoma
Humans
Middle Aged
Outpatients
Polycystic Kidney, Autosomal Dominant*
Positron-Emission Tomography
Takayasu Arteritis*

Figure

• 

  Fig. 1 Contrast-enhanced abdominopelvic computed tomography, showing numerous cysts in the liver and both kidneys.

• 

  Fig. 2 Esophagogastroduodenoscopy. External compression is noted at the lower body, antrum, and duodenal bulb (arrowheads).

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  Fig. 3 Computed tomography angiography, showing multifocal pseudoaneurysms (arrowheads) of the esophageal artery from the left gastric artery (arrow), with a suspected hematoma along the esophageal wall.

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  Fig. 4 Angiography (arteriography of the superior mesenteric artery). A 9-mm pseudoaneurysm(circle) was found in the esophageal artery and it was confirmed that it communicated with the distal left gastric artery (arrow). The distal portion of the esophageal artery was embolized and the esophageal artery was no longer seen (dashed circle) on angiography after the procedure.

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  Fig. 5 Computed tomography angiography with maximum intensity projection reconstruction, showing 50%-70% luminal narrowing of the proximal right axillary artery (arrow) and near-total occlusion of the left common carotid artery from the os to the bulb (arowheads).

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