Hepatic Artery Aneurysms as a Rare but Important Cause of Abdominal Pain; a Case Series

Abstract

Hepatic artery aneurysm (HAA) is the common visceral aneurysms with the highest reported rate of rupture. The clinical manifestations depending on the size of the aneurysm include epigastric pain, obstruction of biliary tract, rupture and death. Imaging modalities like computed tomography (CT) scan and CT-angiography have a valuable role in the early detection of HHAs. Complications and selecting appropriate treatments depending on the size and location of the aneurysms. This article aimed to report clinical presentation, imaging finding and treatment of some patients presenting with HAAs to emergency department.

Keywords: Aneurysm; abdomen; abdominal pain; acute; angiography; hepatic artery.

Figure 1

A) Axial contrast-enhanced CT (CECT) scan demonstrate contrast filled saccular out-pouching at the level of the left hepatic artery (black arrow). Hemoperitoneum with areas of higher attenuation indicates acute active bleeding is present. Peripheral segmental liver hypo-densities due to de-vascularization and vasospasm are also evident. B) Axial CECT through the celiac trunk level shows left gastric artery aneurysm with intraluminal thrombosis. C) Coronal Maximum Intensity Projection (MIP) reformation demonstrates concomitant aneurysm of hepatic artery (long arrow) and left gastric artery (short arrow). D) A volume-rendered 3D CT angiography image displays a small saccular left gastric artery aneurysm

Figure 2

E, F) Axial contrast-enhanced CT (CECT) scan in arterial phase reveals out-pouching pseudo-aneurysm in hepatic artery branch along with intra parenchymal and sub-capsular liver hematoma (arrow). G) Selective digital subtraction angiography (DSA) from hepatic artery shows large pseudo-aneurysm in right hepatic artery. The patient underwent coil embolization for treatment of aneurysm. H) Aneurysm disappears after embolization

Figure 3

I, J) Axial computed tomography (CT) angiogram showing spontaneous saccular aneurysm in proper hepatic artery with peripheral thrombosis and internal diameter of 44 mm, and evidence of hematoma (white arrow) with compression to second part of duodenum and the head of pancreas. K) Volume-rendered 3D CT angiography image displays aneurysm from common hepatic artery (red arrow) and hematoma (black arrow) below it. L) The patient was referred one week after surgical repairing following abdominal pain. Contrast-enhanced CT (CECT) scan finding showed necrotizing center with severe edema around the head of pancreas with extension to porta-hepatis, peri-portal, and anterior sub-hepatic space suggestive of acute necrotizing pancreatitis

Figure 4

A) Ultrasound showed a hyper echo heterogeneous ill-defined lesion (arrow) in the right lobe of liver measuring 30*40 mm in favor of hematoma. B) Axial contrast-enhanced CT scan correlated with ultrasound finding (arrow). The patient underwent conservative treatment. C, D, E) One month later, ultrasound revealed a 23*23 mm hyper echo lesion with central 14*14 mm hypo echo vascular area in segment 8 of liver (an aneurysmal lesion). F) Axial T2W MRI showed a round hyper signal lesion (arrow), the same signal with aorta. G, H) Selective digital subtraction angiography (DSA) from right hepatic artery shows pseudo-aneurysm in right hepatic artery. The patient underwent coil embolization for treatment of aneurysm (arrow) and aneurysm disappeared after embolization (arrow)

Figure 5

I, J, K) Axial contrast enhanced computed tomography (CECT) scan in arterial phase and coronal reformatted images from liver show pseudo-aneurysm in right hepatic artery (arrow) with infected liver hematoma containing gas density and also sub-capsular hematoma