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Hepatic artery pseudoaneurysm rupture: A case report.
Devansh Shah1, Thomas Young Chul Oh2,3, Tony Cy Pang4,2,3
1Department of Surgery, Westmead Hospital, Westmead, New South Wales, Australia.
Trauma Case Reports
|November 30, 2023
Summary
Delayed rupture of a hepatic artery pseudoaneurysm after blunt liver trauma can be fatal. Repeat CT scans may be beneficial for high-grade liver injuries, especially those involving the porta hepatis, to detect rare extrahepatic pseudoaneurysms.
Area of Science:
- Trauma Surgery
- Vascular Surgery
- Radiology
Background:
- Hepatic artery pseudoaneurysms are rare, delayed complications of blunt hepatic trauma.
- Non-operative management is common for blunt liver injuries, but carries risks.
Observation:
- A patient with Grade IV liver laceration managed non-operatively developed a ruptured extrahepatic proper hepatic artery pseudoaneurysm on day 16.
- The patient experienced hemorrhagic shock and cardiac arrest, succumbing to pulmonary complications despite surgical repair.
Findings:
- The literature shows conflicting evidence on routine repeat CT scans for asymptomatic blunt hepatic trauma patients.
- Extrahepatic pseudoaneurysms are rarer than intrahepatic ones, and their detection via repeat CT is debated.
- Current guidelines often do not recommend repeat imaging, despite some studies suggesting utility in high-grade injuries.
Implications:
- Repeat imaging should be considered for high-grade liver injuries (Grade IV or higher) extending to the porta hepatis.
- This approach may aid in the early detection of potentially life-threatening extrahepatic hepatic artery pseudoaneurysms.
- Further research is needed to clarify guidelines on surveillance imaging after blunt hepatic trauma.
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