Delayed Rupture of Mycotic Hepatic Artery Aneurysm in a Patient with Infective Mitral Endocarditis-First Case in Korea

Abstract

Mycotic aneurysms of the hepatic artery are usually caused by mycotic infection in patients suffering with bacterial endocarditis. Mycotic aneurysms have become very rare recently due to early intensive antibiotic treatment for infective endocarditis. Despite of the non-specific symptoms, these aneurysms show a high possibility of sudden death if thye ruptured. Therefore, early detection and surgical repair of aneurysms are very important. We report here on a case of hepatic artery mycotic aneurysm that presented as sudden shock and rupture. (Korean Circulation J 2007;37:43-46) KEY WORDS：Hepatic artery；Aneurysm；Rupture；Shock；Endocarditis.

A Case of Ruptured Mycotic Hepatic Artery Aneurysm Successfully Treated Using Arterial Embolization

“…11 A palpable mass and abdominal bruits are occasionally observed in cases of large HAAs. 9 In our case, the only symptom was right upper quadrant abdominal pain. Despite the relative low incidence of HAA among visceral aneurysms, HAA has the highest rate of rupture (44%) among such aneurysms.…”

“…4 The etiologies of HAA are numerous. 2,9 Prior to the introduction of antibiotics, most HAAs were mycotic and were associated with bacterial endocarditis. 8 Currently, however, atherosclerosis is the most common cause of hepatic artery aneurysm.…”

“…The common hepatic artery is the most frequent site (63%), followed by the right hepatic artery (28%), the left hepatic artery (5%), and both hepatic arteries (4%). 9,10 The average HAA size is approximately 3.5 cm, with a range of 1.5 to 14 cm, and symptomatic aneurysms are typically 2 cm in size. 4 Most HAAs are asymptomatic.…”

“…4 Most HAAs are asymptomatic. 4,9 When symptomatic, the most common complaint is the right upper quadrant abdominal pain which radiates to the back. 11 One third of patients show Quincke's symptom triad of abdominal pain, obstructive jaundice and hemobilia.…”

Ruptured mycotic hepatic artery aneurysm associated with methicillin sensitive staphylococcal endocarditis

“…Most prevalent sites of involvement are the aorta, the peripheral artery, the cerebral artery, and the visceral arteries such as the superior mesenteric artery and the liver, spleen and kidney's arteries [15]. In hepatic artery aneurysm, the common hepatic artery is the most prevalent site (63%), and then the right hepatic artery (28%) is the most prevalent, but the left hepatic artery (5%) is less involved, and at the end both right and left hepatic arteries involved together are the rarest cases (4%) [16]. Mycotic aneurysm in our patient was sited in his right hepatic artery, and mycotic hepatic artery aneurysms demonstrate high risk of rupture [4].…”