Hepatic Artery Pseudoaneurysm Rupture: A Case Report and Review of the Literature

• Published in: The Journal of emergency medicine Vol. 44; no. 1; pp. 100 - 103
• Main Authors: Reiter, Dena A., MD, Fischman, Aaron M., MD, Shy, Bradley D., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 2013
• Subjects: Adult; Aneurysm, False - diagnostic imaging; Aneurysm, False - therapy; Aneurysm, Ruptured - diagnostic imaging; Aneurysm, Ruptured - therapy; critical care; embolization; Embolization, Therapeutic; Emergency; Female; hemoperitoneum; Hepatic Artery - diagnostic imaging; Humans; pseudoaneurysm; resuscitation; Rupture, Spontaneous; Tomography, X-Ray Computed; critical care; resuscitation; hemoperitoneum; embolization; pseudoaneurysm
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2011.08.021

Abstract Background Ruptured hepatic artery pseudoaneurysm, a type of visceral artery aneurysm, is a rare condition that is life threatening if not diagnosed and treated rapidly in the emergency department (ED). Patients presenting with this condition require aggressive resuscitation. Endovascular embolization is the first-line treatment option. Objectives We present a case of spontaneously ruptured hepatic artery pseudoaneurysm and provide a review of the current literature on this topic, focusing on appropriate ED management. Case Report A 41-year-old woman with a history of systemic lupus erythematosus and multiple hepatic bilomas presented to the ED in critical condition with sudden onset of severe abdominal pain and hemodynamic instability. She was found to have a ruptured hepatic artery pseudoaneurysm with marked hemoperitoneum on computed tomography angiography. She was aggressively resuscitated and successfully managed via endovascular embolization. Conclusion Ruptured hepatic artery pseudoaneurysm is a life-threatening condition that must be rapidly diagnosed and managed in the ED. Visceral artery aneurysm rupture is a diagnosis that should be considered in any patient presenting to the ED with hemodynamic instability and abdominal pain. Definitive management is with endovascular embolization.