Rapid Interval Development of a Left Hepatic Artery Pseudoaneurysm During Acute Interstitial Edematous Pancreatitis

Visceral artery pseudoaneurysms are uncommon but potentially life-threatening vascular complications of acute pancreatitis. They are most frequently reported in association with necrotizing or chronic pancreatitis and typically develop weeks after disease onset. Hepatic artery pseudoaneurysms are particularly rare. We report a 70-year-old man with presumed idiopathic acute interstitial edematous pancreatitis whose serial contrast-enhanced computed tomography (CT) examinations documented interval development of a left hepatic artery pseudoaneurysm within four days of presentation despite the absence of pancreatic necrosis, pseudocyst formation, or walled-off necrosis. Initial imaging demonstrated uncomplicated interstitial edematous pancreatitis without vascular abnormalities. Repeat imaging obtained because of worsening abdominal pain and abdominal distension revealed a new 2.3 × 2.0 cm enhancing lesion contiguous with the left hepatic artery, highly suspicious for pseudoaneurysm. Shortly after imaging, the patient developed pulseless electrical activity cardiac arrest and died despite prolonged resuscitative efforts. This case broadens the recognized spectrum of pancreatitis-associated vascular complications by demonstrating rapid interval development of a left hepatic artery pseudoaneurysm during acute interstitial edematous pancreatitis without pancreatic necrosis. It also highlights the importance of repeat vascular assessment, preferably with dedicated arterial-phase imaging when feasible, in patients with worsening symptoms or unexpected clinical deterioration.