Simultaneous Treatment of Unresectable Hepatocelluar Carcinoma and Hepatic Artery Aneurysm, Case Report

Abstract

Hepatic artery aneurysm is uncommon with an estimated incidence of less than 0.25%. Because most patients are asymptomatic, the diagnosis is usually made as an incidental finding on imaging studies performed for other reasons. Because of their propensity to rupture with potential catastrophic intraperitoneal hemorrhage, early diagnosis is important. Herein, relatively asymptomatic aneurysm of the common hepatic artery mostly of atherosclerotic etiology is presented. The importance of imaging findings in the diagnosis of this condition is discussed and relevant literature is reviewed (1, 2). Hepatocellular carcinoma (HCC) ranks among the most common malignancies worldwide, and the prognosis for patients with HCC is typically poor. Chemoembolization has become the mainstay of treatment for patients with unresectable HCC. Transcatheter arterial chemoembolization is intended to deliver a highly concentrated dose of chemotherapy to tumor cells, prolong the contact time between the chemotherapeutic agents and the cancer cells, and minimize systemic toxicity. Ideally, achieving these goals will result in a tumor shrinkage, symptomatic relief, improved quality of life, and increased patient survival (3). We will present a case of male patient, 72 years old, who was referred for transcatheter arterial chemoembolization for unresectable hepatocelluar carcinoma. Helical CT scan showed right lobe mass infiltrating the peritoneum with enhancement in the early arterial phase together with hepatic artery aneurysm that was successfully treated at the same time using emulsion of N-butyl cyanoacylate and lipodol with a concentration of 1:1. Hepatic artery aneurysms are uncommon lesions that have varied clinical presentations. Early diagnosis is essential because the natural tendency of the lesion is to rupture into peritoneal cavity or surrounding organs. Chemoembolization has become the mainstay of treatment for patients with unresectable HCC. Our case is notable, because atherosclerotic aneurysms of the hepatic artery are extremely rare with very few cases reported so far and to diagnose a hepatic artery aneurysm and to treat it in one setting with chemoembolization of unresectable HCC without rupture of the aneurysm is also unusual.