title: Unusual complication after left-lobe liver biopsy for diffuse liver disease: severe bleeding from the superior epigastric artery.
abstract: OBJECTIVE
  Imaging-guided parenchymal liver biopsy for diffuse liver disease is increasingly performed via an epigastric route from the left lobe, as opposed to the more traditional intercostal right-sided approach.
  
  
  METHODS
  We conducted a retrospective analysis of all liver biopsies performed at our department for 3 years (July 2007 through June 2010). A total of 1028 liver biopsies were performed during this period. Of these, 776 biopsies were performed for diffuse medical liver disease. Electronic medical records were reviewed for any documented complications.
  
  
  RESULTS
  We identified six cases (0.8%) of documented significant bleeding after 776 biopsies. All bleeding complications were associated with the left-sided epigastric approach. No documented case of major bleeding from the right-sided approach was recorded during the same period. We describe four patients with severe bleeding complications in which classic imaging features were noted on CT, pointing to injury of the superior epigastric artery as the possible cause of the bleeding.
  
  
  CONCLUSIONS
  It is important to recognize the subtle CT signs of superior epigastric artery bleeding because the traditional femoral approach with angiography of the hepatic and portal vessels may not reveal active bleeding. The superior epigastric artery, rather than the hepatic arteries, should be evaluated. A brachial approach for the angiogram may be the more optimal technique.
authors: Department of Radiology, University of Massachusetts Medical School, Worcester, 01655, USA. vijayarg@ummhc.org
authors: Gopal
authors: G
authors: Vijayaraghavan
authors: David
authors: D
authors: Sheehan
authors: Larry
authors: L
authors: Zheng
authors: Sarwat
authors: S
authors: Hussain
authors: Joseph
authors: J
authors: Ferrucci
mesh_terms: D000328:Adult; D001706:Biopsy / Q000009:adverse effects*; D019074:Epigastric Arteries / Q000293:injuries*; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology*; D006526:Hepatitis C / Q000473:pathology*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D018084:Ultrasonography, Interventional