57-Year-Old Male with Vague Upper Abdominal Pain

Background:

A 57 year old male presented to his gastroenterologist with vague upper abdominal pain and mild elevation in pancreatic exocrine enzymes. Endoscopic ultrasound (EUS) revealed an `aneurysm` within the pancreatic parenchyma. Patient was then referred for Computed Tomographic Angiography (CTA) of the abdomen and pelvis.

Methods:

Imaging findings from EUS and CTA demonstrated several aneurysms within the pancreatic head and uncinate process. Patient was evaluated in Interventional Radiology clinic and referred for angiography/aneurysm embolization.

Results:

Angiography revealed multiple arteriovenous malformations of the pancreas; trans-arterial embolization was performed. Further CTA review demonstrated multiple hepatic arteriovenous malformations (AVM) as well as additional AVM in the pancreatic tail and pulmonary AVM. Overall findings strongly suggest hereditary hemorrhagic telangiectasia (HHT).

Conclusions:

HHT may present atypically with pancreatic `aneurysms`. High index of suspicion based on clinical history and suggestive secondary imaging findings, may lead to proper diagnosis and treatment.