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Case Reports
. 2020 Apr 17;12(4):e7715.
doi: 10.7759/cureus.7715.

Ruptured Hepatic Artery Aneurysm

Amber Mirajkar  1 , Ayanna Walker  1   2 , Sanjiv Gray  3 , Amanda L Webb  4 , Latha Ganti  5   1   6
Affiliations
Case Reports

Ruptured Hepatic Artery Aneurysm

Amber Mirajkar et al. Cureus. .

Abstract

Aneurysmal ruptures are a life-threatening pathology, and while the aorta is the principal location, any aneurysmal rupture can be fatal. Most result from chronic diseases, such as hypertension, diabetes, and vasculitis. Nevertheless, a rupture can result in acute decompensation and must be recognized and addressed quickly to limit morbidity and mortality. The authors describe a case of a 66-year-old female who presented to the emergency department (ED) for abdominal pain and syncope. Even though imaging did not explicitly show the specific site of rupture of the hepatic artery, the positive Rapid Ultrasound for Shock and Hypotension (RUSH) exam and aortic dissection on computed tomography angiography along with her clinical picture (hypotension, abdominal pain, decreased capillary refill, grey skin) raised our suspicions for critical pathology. Exploratory laparotomy revealed a ruptured hepatic artery aneurysm. Her hospital course was complicated by ischemic necrosis of the gallbladder, spleen, and liver, requiring cholecystectomy, splenectomy, and partial hepatectomy, but she was discharged to rehabilitation and expected to make a recovery. This case displays the importance of using ultrasonography early to aid in expedited diagnosis and treatment as well as maintaining a high suspicion for vascular pathology in the setting of hemorrhagic shock.

Keywords: hepatic artery aneurysm.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Existing aortic dissection feeding the celiac trunk (green arrow); hypoechoic capsule seen around liver, thought to be extravasated blood (orange arrow)
Figure 2
Figure 2. Filling of left gastric and common hepatic arteries (orange arrows); downstream filling of 2 out of the 3 branches of the common hepatic arteries (green arrows); aneurysmal disease in the right renal artery
Figure 3
Figure 3. Green arrow demonstrates possible proper hepatic artery aneurysm measuring 9.78 mm (normal: 4-6 mm), but without obvious extravasation
Presence of hypoechoic capsule around the liver, possibly indicating older blood (orange arrow). This finding in the light of a +FAST and clinical picture is what prompted general surgery to take the patient for exploratory laparotomy.
Figure 4
Figure 4. Suprarenal aortic aneurysm with concurrent dissection
Figure 5
Figure 5. Free fluid in the pelvis (arrow)
See this image and copyright information in PMC

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