Hepatic aneurysms are a rare sequela of vascular abnormalities in the liver, including trauma, infection, necrotizing vasculitis such as polyarteritis nodosa (PAN), and iatrogenic and arterial mediolysis. Presentation with intra-abdominal hemorrhage is associated with a high mortality rate. We describe life-saving transcatheter coil embolization of multiple isolated ruptured hepatic pseudoaneurysms in a patient with no history or clinical findings of PAN. We present angiographic findings and intra-arterial transcatheter embolization techniques in the treatment of ruptured large hepatic artery aneurysms. Endovascular specialists should recognize that PAN could present with classic angiographic findings and, in some cases, as life-threatening ruptured isolated hepatic artery aneurysms as its first presentation.
Primary malignant neoplasms of the liver are some of
the most uncommon malignancies in many parts of the world. They
include hepatocellular carcinoma and stromal tumors such as
hepatic angiosarcoma. It is a lethal tumor with life expectancy
of less than six months. Once discovered, it is often too late
for surgical intervention. Like other vascular tumors of the liver
and spleen, intraperitoneal hemorrhage is a well-documented
finding of angiosarcoma which can be lethal if not diagnosed and
treated immediately. As in our case, intraperitoneal hemorrhage
from primary tumor rupture was the only clinical presentation of
this neoplasm. Approximately 15% of patients present with
acute hemoperitoneum from either tumor rupture or peritoneal
metastasis. Although several therapeutic options are available,
we describe apalliative therapy for hepatic angiosarcoma utilizing
transcatheter arterial chemoembolization (TACE) techniques
incorporating the newer embolization agent Embospheres to locally
target and treat this aggressive tumor.
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