The hepatic hyperdensities on the previous CT images are art | Figure 1

SIRRFS

Radiology

The hepatic hyperdensities on the previous CT images are arterial aneurysms. Two contrast enhanced images taken at onset of abdominal pain reveal intraparenchymal bleeding consistent w/ rupture. The 1st intervention image shows active extravasation (blue arrows) from R. hepatic branch & multiple L. hepatic branches. The R. hepatic artery branch was embolized first (2nd image). Images 3 & 4 show L. hepatic artery ultra-selective branch coil embolization w/ coil lengths ranging 4-20 mm. Courtesy of Robert Beasley, M.D., Mount Sinai Medical Center of Florida, Dept. of Interventional Radiology.

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The CT showed the large necrotic pseudocyst with definite contrast extravasation consistent with an arterial pseudoaneurysm. #Interventional #Radiology was consulted for further evaluation and treatment. Given acute hgb loss and symptoms, the plan was to proceed with embolization. The patient tolerated coil embolization without any major complications and recovered well and was discharged home. One month follow up scan demonstrated persistent thrombosis of the splenic artery but the coils had partially migrated into the pseudocyst proper. Coil migration has been described before. And in our case, serial imaging demonstrated stable coil embolic positioning thus not requiring surgical intervention. Has anyone else ever encountered this? What methods do you know to help prevent this from occurring?

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27 year old Hispanic male presented with 1 month of subjective fevers and night sweats. Clinical labs showed S.viridans in blood and transaminitis. He was subsequently diagnosed with mycotic hepatic artery pseudoaneurysm on Doppler US and CTA. Hepatic arteriogram (A,B) showed a 3cm aneurysm arising from the proximal aspect of the superior branch of the anterior division of the right hepatic artery. The aneurysm was embolized using a detachable coil (C,D). After successful embolization, the contrast can no longer be seen filling the aneurysmal sac (E,F). (Case courtesy Joel Ornelas, MD)


60 y/o male preop for extended right hepatic resection for #colorectal liver #Metastases. Ipsilateral #Portal-veins #Embolization using sodium tetradecyl sulfate foam under balloon occlusion and coils and particles for segment 4 #Embolization


#AVF from arterial lines in PICU w/ growing pseudoaneurysm. #Aneurysm and fistula embolized with coils and glue. #RSNA15

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