Liver pseudoaneurysm mimicking haemangioma: a multimodal imaging trap and embolization pitfall

Hepatic artery pseudoaneurysms (HAP) and hepatic haemangiomas (HH) may present with indistinguishable imaging characteristics, particularly when clinical history favors one diagnosis over the other. Primary imaging alone may be insufficient for definitive differentiation. This case highlights the importance of further non-invasive imaging modalities in avoiding unnecessary invasive procedures if clinical condition allows.

A 55-year-old patient presented with abdominal trauma after a fall. Computed tomography (CT) revealed a grade III liver laceration with a hyper vascular lesion near the right hepatic artery, initially suspected to be a HAP. Trans-arterial embolization (TAE) was planned, and selective catheterization was performed. However, angiography showed no pseudoaneurysm filling but rather features suggestive of a haemangioma, leading to the abortion of the procedure. Subsequent magnetic resonance imaging (MRI) confirmed a flash-filling HH. The patient remained stable, with no haemorrhagic complications or need for further intervention.

In emergencies, recognizing imaging features distinguishing haemangiomas from pseudoaneurysms is crucial to avoid unnecessary invasive procedures, especially in stable patients, using accurate non-invasive tools like CT or MRI.