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Post-traumatic hepatic pseudoaneurysms in children
M K Sidhu1, D W Shaw, C P Daly
1Department of Diagnostic Imaging, Children's Hospital Oakland, 747 Fifty Second Street, Oakland CA 94609, USA.
Insights
Post-traumatic hepatic artery pseudoaneurysms in children are rare but can present late after blunt or penetrating trauma. Transcatheter embolization is the preferred treatment for these hepatic artery pseudoaneurysms.
Area of Science:
- Pediatric Surgery
- Interventional Radiology
- Vascular Surgery
Background:
- Post-traumatic hepatic artery pseudoaneurysms are uncommon in pediatric patients.
- These pseudoaneurysms can arise after both blunt and penetrating abdominal trauma.
Observation:
- Three pediatric cases (ages 5-13) with hepatic artery pseudoaneurysms are presented.
- Presentation varied from immediate to 2 months post-trauma.
- Symptoms included fever, gastrointestinal bleeding, hyperbilirubinemia, and widened mediastinum.
Findings:
- Computed tomography (CT) and angiography were used for diagnosis.
- Transcatheter embolization was the primary treatment modality.
- Initial technical success was achieved in all cases, with one recurrence that resolved with conservative management.
Implications:
- Hepatic artery pseudoaneurysms in children require a high index of suspicion due to delayed and unsuspected presentations.
- Endovascular embolotherapy is a safe and effective treatment for pediatric hepatic artery pseudoaneurysms.
- Conservative management can lead to spontaneous resolution in select cases.
Background:
Post-traumatic hepatic artery pseudoaneurysms are rarely seen in children.
Materials And Methods:
We retrospectively reviewed the radiologic studies and medical records of three patients treated at our institution and reviewed the literature. The patients (ages 5-13 years) presented immediately to 2 months after blunt (two patients) and penetrating (one patient) trauma. The hepatic pseudoaneurysms were discovered during work-up for fever (one patient), gastrointestinal bleeding and hyperbilirubinemia (one patient), or widened mediastinum (one patient) on chest radiograph. In two patients, the diagnosis was initially suspected by computed tomography (CT) examination and confirmed by angiography. In the third patient, the diagnosis was made initially by angiography. All three pseudoaneurysms were treated with transcatheter embolization.
Results:
All three embolizations were initially technically successful. However, there was recurrence in one case, in which embolization distal to the neck of the pseudoaneurysms was not technically possible. With conservative management, however, the residual lesion demonstrated spontaneous occlusion by ultrasound (US) at 6 months.
Conclusion:
This uncommon complication of liver trauma in children can have a delayed presentation, can be clinically unsuspected, and can follow blunt or penetrating trauma. Endovascular embolotherapy is the treatment of choice.