Intrahepatic aneurysm in a branch of the right hepatic artery in a patient with vasculitis due to systemic lupus erythematosus

Hepatic artery aneurysms (HAAs) are uncommon, accounting for approximately one-fifth of all visceral artery aneurysms [1]. Recognizing HAAs is crucial due to the potential for complications, such as rupture leading to gastrointestinal and intraperitoneal haemorrhage, and ultimately, patient mortality. The complete aetiology of these aneurysms is still under investigation, but it seems that risk factors include arteriosclerosis, portal hypertension, and, among others, systemic lupus erythematosus (SLE) [2].
A 75-year-old Caucasian female with a history of arterial hypertension and untreated ascending aortic aneurysm presented at her local hospital during her first episode of acute cholecystitis. A computed tomography (CT) scan was performed at the hospital to investigate the cholecystitis, revealing an aneurysm in the anterior branch of the right hepatic artery, measuring 2.2 × 1.7 × 2.3 cm (Figures 1, 2). Initial treatment focused on managing the cholecystitis non-surgically and managing the aneurysm first, based on Tokyo guidelines [3]. Five days after admission, a follow-up CT scan indicated an enlargement of the aneurysm (2.3 × 2.0 × 2.9 cm), raising suspicion of a micro-rupture. Laboratory tests indicated elevated hepatic enzymes. Consequently, the patient was transferred to our clinic for further investigation. Angiography of the celiac branch revealed an intrahepatic aneurysm in a branch of the right hepatic artery (Figure 3), along with thrombosis in the posterior right portal vein, possibly due to external pressure from the aneurysm. No shunt between the aneurysm and portal circulation was evident. The aneurysm was then successfully embolized using metallic micro-coil springs. In addition, another branch of the right hepatic artery was found to be dysplastic in angiography; this raised a suspicion of vasculitis (Figure 4). The patient remained haemodynamically stable, and there was no further deterioration of liver function. Subsequently, total body CT angiography indicated no other aneurysms or other pathological findings and confirmed a successful embolization. The rest of the hospitalization was uneventful, and further testing identified SLE as the underlying cause. Cholecystectomy was scheduled after 6 weeks of discharge. Splanchnic artery aneurysms are rare, with a total prevalence of 0.5%, and they are significant due to the potential for rupture in up to 25% of cases [4]. Pseudoaneurysms are more common (with a prevalence of almost...


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