Isolated Hepatic Artery Dissection in a Nonsurgical Patient: A Case Report and Literature Review

Hepatic artery dissection means a tear in the wall of the hepatic artery, allowing blood to accumulate between arterial layers, leading to fatal or major sequelae, including ischemia and hepatic injury, pseudoaneurysm, or rupture. Spontaneous hepatic artery dissection is rare, especially in patients without any recent hepatobiliary surgery or trauma. It is a nonspecific and often subtle presentation that can delay diagnosis, leading to major/fatal consequences, including hepatic injury due to ischemia, pseudoaneurysm, and rupture leading to death, which highlights the need for clinical awareness. We report on a 54-year-old man with hypertension, type 1 diabetes mellitus, hyperlipidemia, and a remote motor vehicle accident 12 years prior to our case presentation. He presented with acute epigastric pain. Computed tomography angiography (CTA) demonstrated an isolated dissection of the common and proper hepatic arteries without involvement of the aorta or celiac trunk. He was managed conservatively with anticoagulation and close follow-up. Repeat CTA at one month showed interval remodeling and partial recanalization of the hepatic artery. Although a few cases have been reported, they offer insights into risk factors, clinical presentation, and the range of management strategies. Our report underscores the importance of considering vascular causes in patients with unexplained upper abdominal pain. Early diagnosis and a tailored treatment plan can help prevent serious complications.