Rupture of Hepatic Pseudoaneurysm Formed Nine Years after Carbon Ion Radiotherapy for Hepatocellular Carcinoma

Abstract

An 83-year-old man with a history of carbon ion radiotherapy for hepatocellular carcinoma nine years ago presented to a primary care hospital with a fever and abdominal pain. He underwent computed tomography, which revealed the rupture of a hepatic pseudoaneurysm close to the fiducial marker for carbon ion radiotherapy and bleeding into the bile duct. He was successfully treated with transcatheter arterial embolization. Thereafter, re-rupture occurred from a site proximal to the first rupture, and this was treated similarly. It is necessary to be alert for not only tumor recurrence but also pseudoaneurysm occurrence after carbon ion radiotherapy.

Endovascular stenting and coil embolization for management of radiation-induced pseudoaneurysms of the peripheral arteries

“…7 Such pseudoaneurysms can involve the internal or external carotid artery, brachiocephalic artery, hepatic artery, or internal or external iliac artery according to previous reports. 2,7,8,14…”

“…In this regard, endovascular repair consisting of coil or glue embolization and deployment of covered stents was introduced to treat radiation-induced peripheral arterial pseudoaneurysms. 2,[5][6][7][8] Lam et al 9 reported that 23 patients with radiation-induced pseudoaneurysms of the internal carotid artery underwent endovascular therapy and that 20 of these patients achieved successful control of hemorrhage. Radiationinduced pseudoaneurysms of peripheral arteries are rare but life-threatening complications because of the high risk of massive bleeding and the extreme difficulty of open surgery.…”

“…In this regard, endovascular repair consisting of coil or glue embolization and deployment of covered stents was introduced to treat radiation-induced peripheral arterial pseudoaneurysms. 2,5–8 Lam et al. 9 reported that 23 patients with radiation-induced pseudoaneurysms of the internal carotid artery underwent endovascular therapy and that 20 of these patients achieved successful control of hemorrhage.…”

Intratumoral pseudoaneurysm within a liver metastasis of gastric cancer: a case report

“…The causes of visceral artery pseudoaneurysms are trauma, infection, inflammatory diseases, and complications of abdominal surgery, hepatobiliary interventions, and endoscopic explorations [5]. On the other hand, the incidence of pseudoaneurysms caused by malignant tumors is low although pseudoaneurysms caused by hepatocellular carcinomas (HCC), malignant lymphomas, desmoids, neurofibromatosis, giant cell tumors, leukemia, and so on have been reported [6][7][8][9][10][11][12][13].…”

“…Even in ITPA, hepatobiliary interventions like transcatheter arterial chemoembolization and RFA resulting in vascular catastrophe are the most common causes [14][15][16]18]. Yoshikawa et al reported a case of ITPA within an HCC after carbon ion radiotherapy and described the cause as being angiogenesis, fragmentation of the vascular mesothelial elastic fibers, and edema of the subcutaneous blood vessels due to radiation [8]. However, few researchers have reported pseudoaneurysms arising de novo from within a HCC without any prior intervention [6,7].…”