Multiphase multidetector CT in the diagnosis of haemobilia: a potentially catastrophic ruptured hepatic artery aneurysm complicating the treatment of a patient with locally advanced rectal cancer

Abstract

Acute haemobilia is an unusual and potentially catastrophic cause of gastrointestinal bleeding. We describe such a case presenting as a rare complication of a hepatic artery aneurysm following the development and successful treatment of subacute bacterial endocarditis during a radical downstaging chemoradiotherapy regime for locally advanced rectal cancer. We suggest that multiphase multidetector-row CT can have an important role in the diagnosis of acute haemobilia and discuss imaging findings associated with the condition. This case raises awareness of benign conditions mimicking malignancy in oncological patients and reinforces the importance of reviewing historical imaging.

Figure 1

Coronal reconstruction of an unenhanced CT demonstrating a hyperdense common bile duct (arrow) representative of acute haemorrhage within the biliary tree. Note also the surgical drain placed at the time of laparotomy seen en face beneath the gallbladder.

Figure 2

Acute multiphase axial CT at (a) pre-contrast, (b) arterial phase and (c) portal venous phase. This demonstrates initial hyperdensity at the site of the lesion, followed by contrast blush on arterial phase imaging and persistence of this on the portal venous phase scan (arrows). This represented a ruptured hepatic artery aneurysm.

Figure 3

Contrast-enhanced staging CT performed before (a) and after (b,c) the development of subacute bacterial endocarditis complicating chemotheradiotherapy. (b) Axial and (c) coronal reconstructions were performed 3 months prior to the acute presentation demonstrating an enhancing lesion consistent with a hepatic artery aneurysm (arrows).

Figure 4

Coeliac angiography demonstrating the aneurysm (a) prior to and (b) following metallic coiling.