Pancreatic Arteriovenous Malformation: A Case Report of Hemodynamic and Three-Dimensional Morphological Analysis Using Multi-Detector Row Computed Tomography and Post-Processing Methods

Context Although rare, a pancreatic arteriovenous malformation can have serious consequences. A diagnosis of arteriovenous malformation requires evidence of aberrant communication between the arterial and the venous systems. This report describes a case where the use of multi-detector row CT and specific post-processing methods provided a diagnosis of arteriovenous malformation. This minimally invasive diagnostic approach resulted in a clear, precise and comprehensive visual representation of the pancreatic arteriovenous malformation. Case report A 60-year-old man with right hypochondriac pain presented with a mass in the head of the pancreas. The hypochondriac pain resolved spontaneously and physical examination revealed no abnormal findings. A multidetector row CT study was performed. The data obtained in the arterial phase demonstrated a high-contrast mass in the head of the pancreas and early enhancement of the portal vein. A maximum intensity projection method clarified the aberrant vascular communication. Changes in Hounsfield numbers were observed using a multi-planar reformation method. A volume-rendering method was used to create a 3D model which demonstrated the spatial relationship between the aberrant vascular communication and the surrounding tissue. An annual follow-up study using this technique showed no significant alteration. Conclusions Multidetector row CT with specific post-processing methods is a useful diagnostic tool for pancreatic arteriovenous malformation.

Author(s): Naohiro Sata, Kazuhiro Endo, Kunihiko Shimura, Yoshikazu Yasuda

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