Spontaneous Rupture of Hepatic Artery Aneurysm Associated with Polyarteritis Nodosa

Abstract

Polyarteritis nodosa (PAN) is a vasculitis, which often involves small and medium sized visceral arteries. This condition may result in multifocal aneurismal formation and end-organ damage. Uncommonly, PAN may present with rupture of hepatic artery aneurysms. Here, we report a rare case of a ruptured intrahepatic aneurysm associated with PAN. A 79-year-old woman presenting with abdominal pain had CT scan of the abdomen, which revealed hematoma in the right hepatic lobe. Visceral angiogram confirmed pseudo-aneurysm of a right hepatic arterial branch, and this was managed with endovascular coil embolization. The diagnosis of PAN was made and corticosteroid therapy was initiated. We also performed a literature review to define this condition's demographics, clinical presentations, and appropriate management. The review revealed 17 published cases of ruptured PAN-related intrahepatic aneurysms. We conclude that unexplained findings of visceral arterial aneurysms should prompt investigations for vasculitis as the etiology.

Current management strategies for visceral artery aneurysms: an overview

“…Treatment is generally indicated for all symptomatic HAAs, pseudoaneurysms, and aneurysms larger than 20 mm in diameter. Multiple HAAs and nonatherosclerotic aneurysms should also be treated, regardless of size, since these HAAs have a high risk of rupture [50]. Moreover, since rupture of extra-parenchymatous HAAs has a high mortality rate, treatment should be considered once these aneurysms are diagnosed [7,22].…”

Report of a case with a spontaneous mesenteric hematoma that ruptured into the small intestine

“…A mesenteric hematoma is most frequently caused by trauma [4] , including postoperative complications [5] , and non-traumatic causes, which rarely occur in associated with mesenteric vascular disease such as aneurysm [7] , [8] and vasculitis [9] . A spontaneous (or idiopathic) mesenteric hematoma is diagnosed if any clinical and pathological findings were not seen during the development of this condition.…”

Evaluation of percutaneous microwave coagulation therapy for hepatic artery injury

“…A 14G specially made puncture needle was placed into the active bleeding roots along the guide line. Each was first injected with 2.5 ml of 0.5 KU/mL batroxobin (SolcoBasle, Switzerland), followed by 1.5 ml α-cyanoacrylate [7] [8] [9] [10] .…”

“…Embolotherapy consists of the administration of hemostatic agents, such as gelatin pledgets, alcohol foam, or fibrin sealant, to occlude the bleeding site [6] . These embolization agents have limitations because they may lead to immunologic reactions or may be washed away by blood leaving the wound uncovered [7] [8] [9] [10] . In contrast, cauterization by percutaneous radiofrequency ablation [11] [12] or microwave coagulation [13] [14] specifically targets the vascular injury.…”