Differential diagnosis, investigations, and treatment
Based on the abovementioned findings, we suspected that an aneurysm in the celiac artery or superior mesenteric artery (SMA) region was the cause of the retroperitoneal hemorrhage. However, although celiac and SMA angiography revealed no aneurysm, SMA angiography showed regional PIPDA narrowing (Figure 2A). After applying contrast, extravascular outflow was observed from the PIPDA lesion, which was considered a dissection (Figure 2B). Coils were placed at the distal and proximal segments of the PIPDA (Figure 2C). Complete occlusion of the PIPDA was confirmed by resolving the contrast leakage from the same site.