title: Successful transarterial embolization for recurrent pseudoaneurysm of the right hepatic artery with acute cholecystitis.
abstract: Pseudoaneurysm of the right hepatic artery is an extremely rare complication of acute cholecystitis. We report a patient with a right hepatic artery pseudoaneurysm associated with acute cholecystitis who was treated successfully by transarterial embolization. We also review the literature on right hepatic artery pseudoaneurysm secondary to acute cholecystitis. A 50-year-old male visited Fujieda General Municipal Hospital with an episode of sudden headache. He was diagnosed with a subarachnoid hemorrhage and treated successfully by microcoil embolization on hospital day 4. On hospital day 54, he developed fever and right upper quadrant tenderness. Abdominal ultrasonography revealed acute cholecystitis, while color Doppler imaging showed a low-echogenic mass with a pulsatile wave pattern inside the gallbladder. Contrast-enhanced computed tomography (CE-CT) demonstrated a pseudoaneurysm in the gallbladder, and angiography disclosed a right hepatic artery pseudoaneurysm. Selective transarterial embolization (TAE) was then performed using a steel coil. Abdominal pain and fever continued after TAE, with CE-CT showing re-bleeding from the previous pseudoaneurysm. Selective angiography identified extravasation at the same place as the previous pseudoaneurysm from the posterior superior pancreaticoduodenal artery and the inferior pancreaticoduodenal artery via the epicholedochal arterial plexus. TAE was performed resulting in successful occlusion of the pseudoaneurysm.
authors.affiliation: Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan, hangai-tky@umin.ac.jp.
authors.forename: Sho
authors.initials: S
authors.lastname: Hangai
authors.forename: Akihiko
authors.initials: A
authors.lastname: Ohata
authors.forename: Masanobu
authors.initials: M
authors.lastname: Kageoka
authors.forename: Masashi
authors.initials: M
authors.lastname: Mori
authors.forename: Teruyuki
authors.initials: T
authors.lastname: Shimura
authors.forename: Hiroki
authors.initials: H
authors.lastname: Uozaki
authors.forename: Takahiro
authors.initials: T
authors.lastname: Shimamura
authors.forename: Fumitoshi
authors.initials: F
authors.lastname: Watanabe
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Maruyama
mesh_terms: D017541:Aneurysm, False / Q000150:complications* / Q000628:therapy*; D041881:Cholecystitis, Acute / Q000150:complications*; D004621:Embolization, Therapeutic / Q000379:methods*; D006499:Hepatic Artery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012074:Remission Induction