Hepatic artery aneurysm: an unusual case of biliary obstruction

Abstract

A previously healthy 37-year-old man presented with a 2-week history of right upper quadrant pain, jaundice, dark urine, clay-colored stools, pruritis and nausea. Initial evaluation revealed elevated hepatic enzymes, bilirubin, and alkaline phosphatase, but negative hepatitis serologies and no evidence of gastrointestinal bleeding. Workup for vasculitis was negative. Initial abdominal ultrasound revealed a large aneurysm of the hepatic artery with elevation and compression of the common bile duct and porta hepatis. Computed tomographic angiography was performed, revealing multiple visceral aneurysms of the celiac, hepatic, superior mesenteric, and left renal arteries, the largest of which involved the common, proper, and Panel A right hepatic arteries, measuring 3.6 × 3.4 × 7.4 cm (Panels A and B; arrows).

Hepatic artery aneurysm

“…Free rupture occurs with a higher frequency in larger aneurysms and those that are symptomatic and is associated with a high mortality rate. Aneurysms over 2 cm are reported as having a 20–80% risk of rupture and rupture being associated with an 8–21% mortality 2,3 . Aneurysm diameters that are reported in the literature range between 1.5 cm and 14 cm, with those in the upper end of the range, such as our case at 10 cm, being extremely rare.…”

“…Hepatic artery aneurysms are the second most common of all visceral artery aneurysms (false aneurysms account for >50%). The incidence is thought to be increasing with the use of laparoscopic and percutaneous treatments for biliary disease and non‐operative management of blunt abdominal trauma; however, convincing data are absent 1,2 …”

Unusual Cause of Hemobilia

“…The classical presentation of Quincke's triad, comprising abdominal pain, obstructive jaundice, and hemobilia, has been reported in only one-third of the cases. 2 While the vast majority of cases remain asymptomatic, those who present clinically are the ones which rupture having a mortality of around 40%. 3 Visceral artery aneurysms are uncommon but significant vascular lesions.…”