Case Study: Large Hepatic Artery Aneurysm and a Review of the Literature

Abstract

Introduction Hepatic artery aneurysm is a rare and life-threatening lesion. Patients with hepatic artery aneurysm are often asymptomatic, which makes diagnosis difficult. Early diagnosis is essential because of the high risk of rupture. The following case describes an incidental finding of a large hepatic artery aneurysm. Methods A 74-year-old woman presented to the vascular lab for a renal artery evaluation. The patient had hypertension and chronic renal failure with elevated blood urea nitrogen and creatinine. Evaluation of the abdominal aorta was also requested because of a palpable, pulsatile abdominal mass and abdominal bruit. The patient additionally stated epigastric and right upper quadrant pain for the previous 6 months. Results The renal arteries displayed normal flow velocities without evidence of stenosis. Bilateral kidneys did exhibit parenchymal disease. Examination of the abdominal aorta demonstrated an infrarenal abdominal aortic aneurysm measuring 6.4 cm. In the proximal abdomen, at the level of the patient's pain, a large 11-cm aneurysm was identified. because of the large size of the aneurysm causing displacement of the vasculature, the artery of origin was not positively identified. To further delineate this lesion, the patient underwent computed tomography and angiography; however, these were also unsuccessful. The patient was eventually brought to the operating room for surgical repair of this aneurysm as well as her infrarenal AAA. Intraoperatively, the aneurysm was found to be originating from the hepatic artery. Conclusion Although a rare finding, hepatic artery aneurysm can be identified and evaluated with ultrasound. Additional testing with computed tomography and angiography helps to define the arterial source and location of the aneurysm, as well as collateral flow to the liver if the hepatic artery is compromised. Once identified, these lesions need to be surgically or interventionally treated due to their high mortality rate.