Cachexia is consistent with his history of end-stage renal failure and malnutrition. There are numerous pseudocysts in relation to the pancreas and stomach. A small dense focus of contrast enhancement is seen within a cyst in the body of the pancreas best in arterial phase, which becomes less dense on the portal venous and delayed phases.
A large pseudocyst extends through the epiploic foramen and is new compared with previous imaging. Inferiorly, the cyst extends to the right of the aorta to the right common iliac bifurcation, anterior to the IVC. Superiorly, the cyst extends to the porta hepatis, posterior to the portal vein bifurcation. It contains some high-density material suggestive of recent bleed.
Impression:
The pancreatic cyst appearance and the clinic history is suspicious for a small aneurysm or pseudo-aneurysm causing intermittent arterial bleeding into the cyst, and through the pancreatic duct into the duodenum (haemosuccus pancreaticus).