Most patients with hepatic artery aneurysms are asymptomatic and the aneurysm is discovered as an incidental finding on imaging being performed to work up unrelated symptoms or conditions. Patients with a hepatic artery aneurysm may present with abdominal pain, particularly epigastric discomfort, right upper quadrant pain, obstructive jaundice, and/or hemobilia [1] [2] [3]. In rare instances, a patient with a giant aneurysm may present with a pulsatile mass in the right upper abdomen. Patients often become clinically symptomatic when there is erosion into the biliary tree or the portal vein resulting in the development of portal hypertension or rupture of an aneurysm into the peritoneal or retroperitoneal cavity. Approximately one-third of patients present with hemobilia, characterized by jaundice, gastrointestinal bleeding, and biliary colic (Quincke's triad) [4]. Discovery of a hepatic artery aneurysm in an asymptomatic individual occurs as an incidental finding on a computed tomography or ultrasound exam being performed for an unrelated purpose [2] [3].

• Right Upper Quadrant Pain

  Herein, we report the case of a 52-year-old female with new-onset right upper quadrant pain and hypertension. She was found to have hemoperitoneum upon surgical exploration. [ncbi.nlm.nih.gov]

  A 51-year-old man with a history of type B aortic dissection presented with severe right upper quadrant pain. He was febrile and hypotensive. [consultant360.com]

  Patients with a hepatic artery aneurysm may present with abdominal pain, particularly epigastric discomfort, right upper quadrant pain, obstructive jaundice, and/or hemobilia. [symptoma.com]

  Presentation A 65 year old woman with a history of cholecystitis, melanotic stool and resolving jaundice presents with vague right upper quadrant pain. An abdominal ultrasound was performed. Caption: Sagittal view of the liver at the porta hepatis. [sonoworld.com]

• Abdominal Bruit

  Kamath Medicine Mayo Clinic proceedings 2007 The diagnosis of splanchnic artery aneurysm should be considered in any patient with abdominal pain, a pulsatile mass, or an abdominal bruit with or without associated bleeding, however, mostAneurysms are asymptomatic [semanticscholar.org]

  The classic triad of abdominal pain, haemobilia and obstructive jaundice is seen in only 30% of the patients [3], [4]. On examination abdominal bruit or a pulsatile mass may be found. [jpgmonline.com]

  Otherwise they may present with especially abdominal pain, nausea, vomiting and as a pulsatile mass or abdominal bruit. Some Aneurysm are not discovered until they complicate with rupture. [atmph.org]

• Vascular Disease

  The great improvement in the diagnosis of vascular diseases and the increasing incidence of atherosclerosis have resulted in a wider recognition of these pathologies. [ncbi.nlm.nih.gov]

  diseases I73.0 Raynaud's syndrome I73.00 …… without gangrene I73.1 Thromboangiitis obliterans [Buerger's disease] I73.8 Other specified peripheral vascular diseases I73.89 Other specified peripheral vascular diseases I73.9 Peripheral vascular disease [icd10data.com]

  WHY WE WERE FOUNDED Center for Vascular Awareness, Inc. was formed in 2004 to educate the community about vascular disease and keep the issue of vascular health at the forefront of the public's mind. [myvascularhealth.org]

  Her connective tissue disease workup, including antinuclear antibodies, was negative. Echocardiography showed normal valvular and myocardial functions. No history of diabetes or peripheral vascular disease was found. [atmph.org]

• Wide Neck

  In cases of a wide aneurysm neck, a similar technique to the one employed in neurovascular interventions can be used in which the neck can be supported by the use of a wide, open-cell, self-expandable stent. [evtoday.com]

Most diagnostic algorithms for patients presenting with symptoms associated with hepatic artery aneurysm (e.g. mid-epigastric discomfort, abdominal pain) include imaging. The most common imaging modalities used to evaluate hepatic artery aneurysm (and generalized abdominal pain) are ultrasound scan (US), computed tomography (CT) scan with contrast, and angiogram.

On the US, a hepatic artery aneurysm may appear as a mixed echogenic mass with cystic and solid components. Calcifications are usually present in the wall of an aneurysm [5] [6]. Color doppler will demonstrate turbulent or arterial pulsatile flow that is suggestive of the lesion being vascular in origin. US can be used to rule out other vascular conditions such as arteriovenous malformations or fistulas [7] [8] [9].

Hepatic artery aneurysm can be diagnosed by a contrast-enhanced CT scan or three-dimensional CT scan. In general, a CT scan will demonstrate the characteristics of an aneurysm, adjacent anatomical structures, and any signs of rupture. Calcifications will usually be present in the vessel's wall. Thrombotic deposits in the vessel's lumen appear as ring-shaped or semilunar areas of hypodensity. Intravenous contrast allows a more definitive view of the vessel lumen.

A CT angiogram is able to further delineate small aneurysms and provide anatomical details including identification of the artery of origin. Use of CT angiogram often provides a definitive diagnosis, without the need of angiography, however, intravenous contrast is contraindicated in some patients with renal dysfunction [10] [11].

Three-dimensional contrast-enhanced magnetic resonance imaging (MRI) angiography may also be used for the diagnosis of hepatic artery aneurysm in lieu of angiography. Three-dimensional MRI is a quick, sensitive, accurate test and it provides better delineation of the arterial anatomy [12] [13].

Angiography is considered the gold standard diagnostic test for hepatic artery aneurysm. It is highly efficacious with a sensitivity of 100% [13]. Angiography, while invasive, permits diagnosis, identification of additional aneurysms, feeding vessels, and provides information necessary for treatment of an aneurysm [14].

• Entamoeba Histolytica

  Surgical treatment resolved peritonitis but Entamoeba histolytica was detected in the colonic mucosa. [ncbi.nlm.nih.gov]

There is still a lack of studies demonstrating the comparative efficacy or inefficacy of any particular treatment, so there are currently no precise indications for determining which type of treatment should be used. [ncbi.nlm.nih.gov]

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. [ncbi.nlm.nih.gov]

While only four patients had successfully undergone surgical repair prior to 1951, vascular techniques have improved the previous grave prognosis. [jamanetwork.com]

Treatment and prognosis Treatment options include: trans-catheter coil embolization surgery (historically treated with surgery) Once successfully treated (embolotherapy, surgical resection), prognosis is generally good for an individual lesion. [radiopaedia.org]

The prognosis of hepatic aneurysms The prognosis of the disease depends largely on early diagnosis and the corresponding surgical treatment. Once the rupture of bleeding, mortality is very high. [healthfrom.com]

Park, Kim, Han, Goo, Han, Bae, and Park: Hemobilia from Ruptured Hepatic Artery Aneurysm in Polyarteritis Nodosa Abstract Hemobilia, in patients with the diagnosis of polyarteritis nodosa, is rare at clinical presentation and has a grave prognosis. [kjim.org]

Rupture risk of HAA is poorly defined but seems to correlate with size and etiology. [thoracickey.com]

We conclude that unexplained findings of visceral arterial aneurysms should prompt investigations for vasculitis as the etiology. [ncbi.nlm.nih.gov]

The common hepatic artery is the most frequent location(63%), followed by the right hepatic artery(28%), the left hepatic artery(5%), and both hepatic arteries(4%). 7) The leading etiology is atherosclerosis in 32% of these patients. [synapse.koreamed.org]

Hypoxic hepatitis-epidemiology, pathophysiology and clinical management. Wien Klin Wochenschr 2010; 122: 129-139. [ Links ] 8. Henrion J, Schapira M, Luwaert R, Colin L, Delannoy A, Heller FR. [scielo.isciii.es]

If symptoms occur, or enlargement of the aneurysm, then endovascular or open repair should be considered. [41] Pregnant women (due to high rupture risk of up to 80%) should be treated surgically. [42] Epidemiology [ edit ] Incidence rates of cranial aneurysms [en.wikipedia.org]

Among categorical data, in addition to the epidemiological variables such as age and sex, we considered factors related to arterial and portal hypertension: we therefore evaluated the recipient gender, the presence in the medical history of previous surgery [journals.plos.org]

This report reviews the pathophysiology and management of PAN and the diagnosis and management of HAA. [ncbi.nlm.nih.gov]

References Steer ML: Pathophysiology and pathogenesis of acute pancreatitis; in Bradley III EL (ed): Acute Pancreatitis: Diagnosis and Therapy. New York, Raven Press, 1994. [karger.com]

Hypoxic hepatitis-epidemiology, pathophysiology and clinical management. Wien Klin Wochenschr 2010; 122: 129-139. [ Links ] 8. Henrion J, Schapira M, Luwaert R, Colin L, Delannoy A, Heller FR. [scielo.isciii.es]

Pathophysiology Pseudoaneurysms form when enzyme-rich peripancreatic fluid, often within a pseudocyst, leads to autodigestion and weakening of the walls of adjacent arteries. [emedicine.medscape.com]

This will prevent the wrong diagnosis of vasculitis and subsequent treatment with potentially toxic medications. We present 2 cases of FMD involving the renal and hepatic arteries that illustrate this diagnostic challenge. [ncbi.nlm.nih.gov]

Prevention Prevention of hepatic aneurysm The disease no effective preventive measures, early detection of early diagnosis is the key to prevention and treatment of this disease. [healthfrom.com]

WHO WE ARE Center for Vascular Awareness, Inc. is a 501(c)(3) not for profit organization dedicated to fostering mainstream consumer and clinical consciousness of vascular health standards, disease, prevention and treatment options. [myvascularhealth.org]

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13. Liu Q, Lu JP, Wang F, Wang L, Tian JM. 3D Contrast-enhanced MR angiography of aortic dissection: a pictorial essay. Radiographics. 2007;27:1311-21.
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