Post-traumatic hepatic pseudoaneurysms in children.
BACKGROUND
Post-traumatic hepatic artery pseudoaneurysms are rarely seen in children.


METHODS
We retrospectively reviewed the radiologic studies and medical records of three patients treated at our institution and reviewed the literature. The patients (ages 5-13 years) presented immediately to 2 months after blunt (two patients) and penetrating (one patient) trauma. The hepatic pseudoaneurysms were discovered during work-up for fever (one patient), gastrointestinal bleeding and hyperbilirubinemia (one patient), or widened mediastinum (one patient) on chest radiograph. In two patients, the diagnosis was initially suspected by computed tomography (CT) examination and confirmed by angiography. In the third patient, the diagnosis was made initially by angiography. All three pseudoaneurysms were treated with transcatheter embolization.


RESULTS
All three embolizations were initially technically successful. However, there was recurrence in one case, in which embolization distal to the neck of the pseudoaneurysms was not technically possible. With conservative management, however, the residual lesion demonstrated spontaneous occlusion by ultrasound (US) at 6 months.


CONCLUSIONS
This uncommon complication of liver trauma in children can have a delayed presentation, can be clinically unsuspected, and can follow blunt or penetrating trauma. Endovascular embolotherapy is the treatment of choice.
Sidhu
M K
MK
Department of Diagnostic Imaging, Children's Hospital Oakland, 747 Fifty Second Street, Oakland CA 94609, USA.
Shaw
D W
DW
Daly
C P
CP
Waldhausen
J H
JH
Coldwell
D
D
D000007:Abdominal Injuries / Q000150:complications* / Q000175:diagnosis; D000293:Adolescent; D017541:Aneurysm, False / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D015901:Angiography, Digital Subtraction; D002648:Child; D002675:Child, Preschool; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000293:injuries; D006801:Humans; D009104:Multiple Trauma / Q000150:complications / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D013898:Thoracic Injuries / Q000150:complications / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D018608:Ultrasonography, Doppler; D014948:Wounds, Gunshot / Q000150:complications / Q000000981:diagnostic imaging; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000000981:diagnostic imaging