Presentation
Patient presented with upper tract GI bleeding and jaundice.
Patient Data
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Proximal pseudoaneurysm coiled five days prior to imaging. Two new pseudoaneurysms have developed - one distal to the embolized pseudoaneurysm, and one proximal.
Figure 1: Presence of distal pseudoaneurysm noted. No bleeding present.
Figure 2: Bleeding noted in distal pseudoaneurysm. Jet of contrast from top of pseudoaneurysm is compatible with extravasation and active bleeding.
Figure 3: Coiling of distal pseudoaneurysm five days after initial imaging. A third new proximal pseudoaneurysm to the other two pseudoaneurysms is noted.
Case Discussion
The patient previously had surgery to remove the right hepatic lobe for a hepatic adenoma. This may have led to ascending cholangitis, which predisposes the hepatic artery to multiple pseudoaneurysms via inflammation. The formation of multiple pseudoaneurysms indicates that the arterial walls were affected by cholangitis.
Initial embolization performed by Richard Archer, MD. Second embolization performed by Rakesh Shah, MD.
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