Association between radiological characteristics of hemorrhagic pancreatic pseudocyst and endovascular embolization site

Hemorrhagic pancreatic pseudocysts (HPP) is a life-threatening complication. Endovascular embolization (EVE) of related visceral arteries plays an important role in treatment strategy. The aim of this study was to assess radiological findings of HPP and the association to the site of EVE. In retrospective single center case control study patients with HPP and EVE of related visceral artery between years 2014 - 2019 were included.Radiological appearance of HPP, location, potential source of bleeding was evaluated in computed tomography (CT). Correlation to EVE site performed by IBM SPSS program. 52 patients: 80%(n= 42) - male, 20%(n=10) – female, mean 46,5 (range 27-78) years were included. HPP was significantly prevalent in patients with acute pancreatitis 80% (n= 42) (p< 0.05 ), 14% (n=7) had chronic pancreatitis, 6% (n=3) – defined as normal. Pseudoaneurysm found in 27% (n=14), in 73% (n=38) exact bleeding site was not detectable. Intracystic haemorrhage found in 52% (n=27), direct bleeding from HPP to gastrointestinal tract - 15% (n=8), intracystic + gastrointestinal tract bleeding -15% (n=8), retro- /intraperitoneal haemorrhage -15% (n=8), intracystic + intraabdominal hemorrhage - 2% (n=1). Anatomical distribution of HPP in pancreas : 25% - head; 27%- body, 48% - tail.In HPP of pancreatic head EVE of a.pancreaticoduadenalis (46%, n=6) and a.gastroduadenalis (46%, n=6) most often performed. In HPP of pancreatic body EVE of a.lienalis - 79% (n=11) and a. gastric sinistra 14% (n=2); a.gastrica sinistra+a.lienalis- 7% (n=1). In HPP of pancreas tail EVE a.lienalis most often performed (84%, n=21).Statistically significant correlation between HPP in pancreatic body/tail and EVE of a. lienalis was found (p<0.05). HPP more frequently occurs in patients with acute pancreatitis. Strong correlation between location of HPP in pancreas body/tail and EVE of a. lienalis was found thus showing the crucial relevance of preoperative CT.