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Case Reports
. 2025 Aug 1;64(15):2328-2331.
doi: 10.2169/internalmedicine.4814-24. Epub 2025 Feb 8.

A Rare Case of Severe Pulmonary Embolism Complicated by the Rupture of a Pancreaticoduodenal Artery Aneurysm Due to Median Arcuate Ligament Syndrome and Left-sided Inferior Vena Cava

Daichi Yomogida  1 , Suguru Hasegawa  1 , Shiori Mizuta  1 , Shinjiro Horikawa  1 , Yoshinao Koshida  1 , Masaaki Kawakami  2
Affiliations
Case Reports

A Rare Case of Severe Pulmonary Embolism Complicated by the Rupture of a Pancreaticoduodenal Artery Aneurysm Due to Median Arcuate Ligament Syndrome and Left-sided Inferior Vena Cava

Daichi Yomogida et al. Intern Med. .

Abstract

A 70-year-old man with a history of left-sided renal donation surgery 11 days earlier developed rupture of a pancreaticoduodenal artery (PDA) aneurysm caused by median arcuate ligament syndrome (MALS). The patient also had a congenital anomaly and left-sided inferior vena cava (IVC). Surgical hemostasis was performed; however, the patient developed a massive pulmonary embolism on day 4 of hospitalization. Chest contrast-enhanced computed tomography revealed compression of the IVC by the abdominal aorta and a hematoma resulting from aneurysm rupture, which was considered the source of deep vein thrombi. Although PDA aneurysms related to MALS and left-sided IVC are rare conditions, PDA aneurysm rupture is life-threatening, and left-sided IVC presents a potential risk for deep vein thrombosis. However, comprehensive management strategies for these conditions have not yet been established.

Keywords: deep vein thrombosis; left-sided inferior vena cava; median arcuate ligament syndrome; pancreaticodudenal artery; pulmonay embolism.

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Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.
Figure 1.
Abdominal contrast-enhanced computed tomography on admission shows (a) a hematoma around the pancreatic head extending to the descending part of the duodenum (circle) and (b) stenosis of the celiac artery due to MALS in the axial view (arrow) and (c) sagittal view (circle).
Figure 2.
Figure 2.
Angiography on admission shows (a) the anterior superior PDA (arrow) and the posterior superior PDA (dashed arrow) and (b) the aneurysm in the posterior superior PDA (circle).
Figure 3.
Figure 3.
Chest contrast-enhanced CT on hospital day 4 shows (a) a bilateral massive pulmonary embolism (arrows) and (b, c) compression of the IVC by the hematoma and abdominal aorta (arrow and circle). (d) Abdominal contrast-enhaced CT before nephrectomy shows no IVC compression (circle).
See this image and copyright information in PMC

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