Coil embolization of multiple hepatic artery aneurysms in a patient with undiagnosed polyarteritis nodosa

Hepatic aneurysms are a rare sequela of vascular abnormalities in the liver, including trauma, infection, necrotizing vasculitis such as polyarteritis nodosa (PAN), and iatrogenic and arterial mediolysis. Presentation with intra-abdominal hemorrhage is associated with a high mortality rate. We describe life-saving transcatheter coil embolization of multiple isolated ruptured hepatic pseudoaneurysms in a patient with no history or clinical findings of PAN. We present angiographic findings and intra-arterial transcatheter embolization techniques in the treatment of ruptured large hepatic artery aneurysms. Endovascular specialists should recognize that PAN could present with classic angiographic findings and, in some cases, as life-threatening ruptured isolated hepatic artery aneurysms as its first presentation.