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

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.