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ABDOMEN / Abdomen vessel   43 / M,  Abnormality on follow up CT after liver biopsy
2020-05-16
About Author
Authors Soo Jin Kim
Institution NCC
E-mail sjkim@ncc.re.kr
About Case
Chief complaint
or Title
Abnormality on follow up CT after liver biopsy
Subspecialty ABDOMEN / Abdomen vessel
Classification Trauma / hemoperitoneum
Age 43 Sex M
Difficulty For resident, For specialist
Modality CT, Angiography
Case Figures
Click above Figure for more images.
Questions
What's your diagnosis?
Answer
Diagnosis Recurrent bleeding from pseudoaneurysm of Lt. inferior phrenic artery.
Comments

Precontrast CT shows high attenuated fluid-debris level in the pelvis along dependent area suggesting hemoperitoneum and acute/subacute state of recent bleeding.



 

It is always challengable but doable to detect the orgin of bleeding. When I found out a tiny saccular abnormal structure corresponding to Lt. inf. phrenic artery, the main operator who conducted total gastrectomy also suspected iatrogenic injury to that vessel by electrocautry during the operation. 

Diagnostic and therapeutic angiography was performed. However, actually the embolization for that tiny  pseudoaneurysm was technically failed due to very stiff angulation of celiac os. Then, interventional radiologist just performed the embolization at S6 biopsy site with suspicion of woozing and possibility of delayed bleeding from the biopsy site also.

Pathology report for S5/6 biopsy lesion was hemangioma, clinically suspected as early liver mets. 

 



 

Two weeks later, when patient showed hypotension, CT angiography definitely revealed increased size of a saccular pseudoaneurysm of Lt. inf. phrenic artery especially it was well demonstrated on MRP and 3D reconstruction images.

After multiple trials with every different interventional devices, finally the embolization for LIPA pseudoaneurysm had succeeded, the saccular filling of contrast media was disappeared on postembolization spot image. 

 



 

References 1) Pasha SF, et al. Splanchnic artery aneurysms. Mayo Clin Proc. 2007;82(4): 472-479
2)  Shanley CJ, et al. Uncommon splanchnic artery aneurysms: Pancreaticoduodenal, gastroduodenal, superior mesenteric, inferior mesenteric, and colic. Ann Vasc Surg. 1996;10:506-515
3) Panayiotopoulos YP. et al. aneurysms of the visceral and renal arteries. Ann R Coll Surg Engl. 1996;78:412-419
Keywords pseudoaneurysm, inferior phrenic artery, intraoperative trauma
Attachment File -

Number of Applicants : 35
Correct Answer 27
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