title: Unruptured cystic artery pseudoaneurysm accompanied by Mirizzi syndrome: a report of a case.
abstract: Pseudoaneurysm of the cystic artery is a rare complication of cholecystitis. 34 cases have been reported from 1976 to 2012, searched on MEDLINE and most of the cases have presented with gastrointestinal bleeding. We report the third case of an unruptured pseudoaneurysm of the cystic artery associated with calculous cholecystitis. An 85-year-old female presented to the emergency unit with epigastric pain and jaundice. Laboratory data and contrast-enhanced computed tomography (CT) revealed calculous cholecystitis and Mirizzi syndrome accompanied by a pseudoaneurysm in the gallbladder. Color Doppler ultrasonography (US) clearly demonstrated the pulsatile pseudoaneurysm. After biliary drainage and antimicrobial therapy, selective hepatic angiography with the aim of providing transcatheter arterial embolization was performed but the pseudoaneurysm had already thrombosed spontaneously. Open cholecystectomy was successfully carried out. Histological specimens demonstrated the pseudoaneurysm with organized thrombus in the epithelial wall of the gallbladder thickened with severe fibrosis. It is suggested that cholecystitis with unusual symptoms such as gastrointestinal bleeding requires immediate enhanced CT and US with Doppler imaging in order not to overlook a rare but life-threatening pseudoaneurysm.
authors.affiliation: Asahikawa City Hospital, 1-65, Kinseicho 1-chome, Asahikawa, Hokkaido, Japan. woodbell3104@hotmail.com.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Suzuki
authors.affiliation: Asahikawa City Hospital, 1-65, Kinseicho 1-chome, Asahikawa, Hokkaido, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Saito
authors.affiliation: Asahikawa City Hospital, 1-65, Kinseicho 1-chome, Asahikawa, Hokkaido, Japan.
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Nakamura
authors.affiliation: Asahikawa City Hospital, 1-65, Kinseicho 1-chome, Asahikawa, Hokkaido, Japan.
authors.forename: Ryuji
authors.initials: R
authors.lastname: Sukegawa
authors.affiliation: Asahikawa City Hospital, 1-65, Kinseicho 1-chome, Asahikawa, Hokkaido, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Chiba
authors.affiliation: Asahikawa City Hospital, 1-65, Kinseicho 1-chome, Asahikawa, Hokkaido, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Nakajima
authors.affiliation: Asahikawa City Hospital, 1-65, Kinseicho 1-chome, Asahikawa, Hokkaido, Japan.
authors.forename: Ryuji
authors.initials: R
authors.lastname: Sugiyama
authors.affiliation: Asahikawa City Hospital, 1-65, Kinseicho 1-chome, Asahikawa, Hokkaido, Japan.
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Ozawa
authors.affiliation: Asahikawa City Hospital, 1-65, Kinseicho 1-chome, Asahikawa, Hokkaido, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Taruishi
authors.affiliation: Asahikawa City Hospital, 1-65, Kinseicho 1-chome, Asahikawa, Hokkaido, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Takada
keywords: Cholecystitis; Color Doppler imaging; Cystic artery pseudoaneurysm; Mirizzi syndrome