Original title: Pitfall in necrotizing pancreatitis: Organized hematoma with arteriovenous fistula mimicking a splenic artery pseudoaneurysm
Sandra López Gordo, Neus Torra, Ana Bernabeu, Ernest Bombuy +1 · September 2026
Severe swelling and tissue death in the pancreas can cause dangerous blood vessel injuries. One feared complication is a pseudoaneurysm, a false bulge in an artery that can burst and cause deadly bleeding. Doctors treated a patient whose medical scans showed a rapidly growing mass near the spleen, swelling from 22 to 54 mm. It looked just like a splenic artery pseudoaneurysm, which usually fills with blood during the arterial phase of a scan. Doctors placed tiny coils into the splenic artery to block blood flow. However, blood kept flowing past the coils, so surgeons removed the spleen. The removed tissue proved the mass was actually an organized hematoma, an old blood clot, joined to an arteriovenous fistula, an abnormal direct link between an artery and a vein. The doctors found that unusual filling during the venous scan phase can help tell these two issues apart.
Imagine you hear a rattling noise in your car and assume it's the exhaust. The mechanic agrees it sounds like the exhaust, replaces it, but the noise comes back. Only after taking the car apart does the mechanic find a loose heat shield hitting the frame — a different problem that sounded identical. Here, a spleen spot looked like a dangerous bleeding artery on scans, so doctors treated it that way; only after removing the spleen did they find a blood clot with an abnormal vessel connection.
For people with severe necrotizing pancreatitis, a splenic artery pseudoaneurysm is dangerous because it can rupture and cause massive bleeding. This case shows a look-alike lesion — an organized hematoma with an arteriovenous fistula — can be mistaken for that emergency on CT and angiography. The right diagnosis only became clear after surgery, so knowing the difference can change treatment decisions.
The abstract doesn't say how common this pitfall is or how often the atypical features appear. It reports a single case, and the correct diagnosis was made only after splenectomy. No comparison group is described, so the imaging clues are suggestive rather than proven.
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Pitfall in necrotizing pancreatitis: Organized hematoma with arteriovenous fistula mimicking a splenic artery pseudoaneurysm — Sandra López Gordo, Neus Torra, Ana Bernabeu et al. — Radiology case reports — doi:10.1016/j.radcr.2026.08.061
Abstract licence: CC BY
Explanation generated by Synthesis from the abstract — it is not the original paper.