Biliary obstruction secondary to hepatic artery aneurysm: cholangiographic appearance and diagnostic considerations

We present 2 patients with biliary compression by hepatic artery aneurysms and, for the first time, a cholangiographic demonstration of this rare cause of extrahepatic obstruction. The clinical features of hepatic artery aneurysms and modalities available for their diagnosis are reviewed. The cholangiographic appearance of smooth, gradual tapering of the biliary tree, although nonspecific, is not typical of the more commonly encountered bile duct carcinoma and should alert the investigator to the possibility of this uncommon diagnosis. Angiography must still be considered the procedure of choice but is unlikely to be performed without the necessary index of suspicion, either on clinical or radiologic grounds.