Cystic artery pseudoaneurysm

Case contributed by Muhammad Imran Khan

Presentation

Cholecystectomy followed by pain abdomen for one year. Unexplained hypochromic microcytic anemia and hematemesis.

Patient Data

Age: 35 years
Gender: Female

An oval lesion is appreciable at the porta hepatis, displaying intense contrast uptake, positioned in relation to cystic artery along the surgical staples of the previous cholecystectomy. 

Also, the common bile duct is visible containing dense material opacifying its lumen entirely, more pronounced in portovenous phase, without obvious intrahepatic biliary dilatation.        

Case Discussion

This patient, a middle-aged female, had undergone a cholecystectomy for gallstones a year ago. She developed episodic abdominal pain, occasional hematemesis and anemia. Her endoscopy was unremarkable. 

She presented again with similar complaints and ultrasound examination revealed a cystic focus at the porta hepatis displaying to-and-fro blood flow along with debris in slightly wide common bile duct (CBD). 

CECT abdomen showed a well-defined lesion in porta hepatis having avid contrast uptake simultaneous to the vessels adjacently and there was high-density material in the CBD.  This led to the diagnosis of pseudoaneurysm of a cystic artery following cholecystectomy and communication with the CBD leading to hemobilia. 

The case was confirmed with super selective angiography and was treated with coiling of pseudoaneurysm, images of which are unfortunately not available.        

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