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.