Left gastric artery pseudoaneurysm mimicking a giant gastric subepithelial lesion

Excerpt

A 45-year-old man was referred to our hospital because of the finding of one large gastric subepithelial lesion and ascites via esophagogastroduodenoscopy (Fig. 1a) and computed tomography (CT) (Fig. 1b), respectively. He presented a 2-month history of general weakness, anorexia, and epigastric pain. He had a history of chronic alcoholic pancreatitis for 7 years. Physical examination revealed pale conjunctivae and mucous membranes. Laboratory data were notable for anemia (8.7 g/dL), hypoalbuminemia (3.3 U/L), and a positive fecal occult blood test. Diagnostic paracentesis showed a bloody peritoneal fluid. Endoscopic ultrasound (EUS) showed a cystic lesion within the muscular layer and multiple heterogenous hyperechogenic spots with septations (Fig. 1c). Fine needle aspiration (FNA) revealed old bloody fluid (Fig. 1d). Emergent CT-angiogram (Fig. 1e) was performed because of an episode of hematemesis 12 days after EUS-FNA. The diagnosis of ruptured left gastric artery pseudoaneurysm (LGAP) was established by arteriography (Fig. 1f). Four weeks after endovascular embolization, repeat CT scan showed the pseudoaneurysm had disappeared.

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