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      An infrequently encountered case of spontaneous subcapsular liver hematoma with hepatic artery pseudoaneurysm

      case-report

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          ABSTRACT

          Hepatic artery pseudoaneurysm (HAP) is a rare complication of liver trauma and liver transplant, and spontaneous subcapsular liver hematoma is not frequently encountered outside the setting of preeclampsia and hemolysis, elevated liver enzyme and low platelet (HELLP) syndrome. We report a rare case of spontaneous subcapsular liver hematoma with hepatic artery pseudoaneurysm without any apparent liver trauma or recent interventional procedures of the hepatobiliary system. Although subcapsular hepatic hematoma and HAP are uncommon diagnoses, clinicians should be aware of these diagnoses to promptly diagnose and effectively treat them. Clinicians should also not forget these diseases could be masked by other common etiologies, such as gastritis.

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          Most cited references17

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          Hepatic artery aneurysm: factors that predict complications.

          We reviewed the Mayo Clinic experience with management and outcome of hepatic artery aneurysms (HAA). Retrospective review of charts for 306 patients with true visceral aneurysm diagnosed from 1980 to 1998 enabled identification of 36 patients (12%) with HAA. Patients with HAA included 23 men and 13 women, with mean age of 62.2 years (range, 20-85 years). Most aneurysms were extrahepatic (78%) and single (92%). Mean aneurysm diameter at presentation was 3.6 cm (range, 1.5-14 cm). Five aneurysms had ruptured (14%), and four were symptomatic (11%). Mortality from rupture was 40%. Of the 9 patients with ruptured or symptomatic aneurysms, 2 patients had multiple HAA, 3 patients had fibromuscular dysplasia, and 2 patients had polyarteritis nodosa. All five HAAs that ruptured were of nonatherosclerotic origin (P =.001). Fourteen patients (39%) underwent elective procedures, including excision with vein graft (n = 7), excision with dacron graft (n = 3), excision alone (n = 2), and percutaneous embolization (n = 2). Two vein grafts and one dacron graft became occluded within 1 year. Nonoperative management was elected in 22 patients (61%) with mean aneurysm diameter 2.3 cm (range, 1.5-5 cm). No complications related to the aneurysm occurred during mean follow-up of 68.4 months (range, 1-372 months). Aneurysm growth was identified in 27%, the greatest being 0.8 cm over 34 months. HAA are at definite risk for rupture (14%). Risk factors for rupture include multiple HAA and nonatherosclerotic origin. Patients with symptomatic aneurysms or any of these risk factors should be considered for intervention.
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            Hepatic artery aneurysm.

            Hepatic artery aneurysms (HAAs) are rare. A review of the English language literature from 1985 to 1995 for reports of visceral artery aneurysms showed HAA to be the most frequently reported visceral aneurysm during that decade. This increase in incidence relates to the increasing use of percutaneous diagnostic and therapeutic procedures. A second factor is the increased use of diagnostic CT scanning after blunt liver trauma. The purpose of this pictorial review is to illustrate the imaging presentation and radiological management of HAAs.
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              Iatrogenic hepatic artery pseudoaneurysms: an uncommon complication after hepatic, biliary, and pancreatic procedures.

              Hepatic artery pseudoaneurysms are uncommon but potentially lethal complications of hepatic, biliary, and pancreatic interventions. To enhance our knowledge about these pseudoaneurysms, we reviewed our institution's experience with the management of these lesions. We reviewed the literature on 136 cases of hepatic artery pseudoaneurysms as well as our experience with 17 patients (excluding patients who were post-transplantation or had suffered abdominal trauma). The causes, pathogenesis, and clinical features were analyzed. Ten women and seven men developed hepatic artery pseudoaneurysms after undergoing hepatic (65%), biliary (30%), or pancreatic procedures (5%). The mean time between initial intervention and diagnosis was 5.7 months (range 7 days-38 months). Rupture occurred in 13 patients (76%). Mean pseudoaneurysm size was 1.9 cm (range 0.7-4 cm). Embolization was successful in 12 of 14 patients (86%). Four patients (24%), including the two who failed embolization, required operative intervention. Postoperative mortality was 25% while postembolization mortality was 14%. One patient was observed, and the aneurysm thrombosed at 72 months follow-up. Mean follow-up was 48 months (range 1-184 months) for 13 of the 14 survivors (93%) (1 patient was lost to follow-up) without any clinical sequela. Hepatic artery pseudoaneurysms are rare. Rupture is common and occurred in 76% of patients. For both ruptured and nonruptured cases angiography with embolization of the pseudoaneurysm is safe and effective. Operative intervention should be reserved for patients for whom embolization fails or for whom it is not feasible.
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                Author and article information

                Journal
                J Community Hosp Intern Med Perspect
                J Community Hosp Intern Med Perspect
                Journal of Community Hospital Internal Medicine Perspectives
                Taylor & Francis
                2000-9666
                26 January 2021
                2021
                : 11
                : 1
                : 81-84
                Affiliations
                [a ]Department of Internal Medicine, Corpus Christi Medical Center – Bay Area; , Corpus Christi, TX, USA
                [b ]Department of Pulmonary Medicine, Corpus Christi Medical Center; , Corpus Christi, TX, USA
                [c ]Department of Nursing, John Hopkins University School of Nursing; , Baltimore, MD, USA
                [d ]Department of Internal Medicine, University of North Texas; , Dallas, TX, USA
                Author notes
                CONTACT Salim Surani srsurani@ 123456hotmail.com Department of Internal Medicine, Corpus Christi Medical Center – Bay Area; , Corpus Christi, 7101 S Padre Island Drive, Corpus Christi, Texas 78412, USA
                Article
                1821468
                10.1080/20009666.2020.1821468
                7850349
                ceeac28d-7f69-446e-999a-40610dd57df0
                © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group on behalf of Greater Baltimore Medical Center.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Page count
                Figures: 2, References: 17, Pages: 4
                Categories
                Case Report
                Case Report

                hepatic hematoma,hepatic artery pseudoaneurysm,angioembolization,blood loss anemia,abdominal pain,transaminitis

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