Cystic artery pseudo-aneurysm: a complication of xanthogranulomatous cholecystitis.
A 54-year-old man presented for radiology with pain and a feeling of fullness in the upper abdomen and an epigastric mass. Ultrasound revealed a large cystic mass with internal echoes, lying posterior and inferior to left lobe of the liver. The gallbladder was thick-walled and contracted, and contained a calculus and echogenic sludge. A cystic structure that produced swirling flow signals on colour Doppler was demonstrated within the gallbladder. The CT scan showed a thickened gallbladder with adjacent inflammation and a 2-cm pseudo-aneurysm in its wall. High-density material was present in the gallbladder lumen, in the extra-hepatic bile ducts and around the gastrohepatic ligament. A thick haemorrhagic pus, from which Escherichia coli was cultured, was drained from the gastrohepatic collection. An elective coeliac angiogram demonstrated a solitary pseudo-aneurysm of the medial branch of the cystic artery. Selective catheterisation of this artery with a micro-catheter enabled complete exclusion of the pseudo-aneurysm by a single micro-coil. Histological examination of the gallbladder, which was ultimately removed at open cholecystectomy, demonstrated xanthogranulomatous cholecystitis.
Ahmed
I
I
Department of Radiology, Aga Khan University Hospital, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan. ishtiaq.chisti@aku.edu
Tanveer
U H
UH
Sajjad
Z
Z
Munazza
B
B
Azeem
U D
UD
Basit
S
S
D017541:Aneurysm, False / Q000000981:diagnostic imaging* / Q000209:etiology; D002764:Cholecystitis / Q000150:complications / Q000473:pathology; D006099:Granuloma / Q000150:complications / Q000473:pathology; D006499:Hepatic Artery / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D014973:Xanthomatosis / Q000150:complications / Q000473:pathology