A right hepatic artery aneurysm incidentally found out during exploration for a soft tissue tumor in the right elbow

Abstract

A 57-year-old woman presented with a soft tissue tumor in the right elbow was incidentally found to have a lesion at the hilum of the liver by abdominal CT scan. Dynamic CT scan revealed that the mass was enhanced in the early phase and had pooling of contrast medium in the late phase. The 3D graphy from volume rendering of the CT angio showed encasement of the right hepatic artery (RHA) and sacculus formation at the peripheral side of the encasement and also a loss of blood flow of the RHA at the distal portion to the sacculus. Laparotomy was performed with a preoperative diagnosis of a pseudoaneurysm of the RHA. The pseudoaneurysm was located at the dorsal aspect of the common bile duct and was encapsulated with connective tissues. The intraoperative color dopplar ultrasound sonography (CDUS) confirmed arterial blood flow in the pseudoaneurysm but no stream beyond it. Under the good knowledge of blood circulation around the pseudoaneurysm, we performed arterial ligation. The post-operative course was uneventful and the patient was discharged on the tenth day after the operation. Dynamic CT and CDUS were useful for the diagnosis and decision-making of procedures of the surgery. Arterial ligation is considered to be one of safe treatments for non-emergency cases of hepatic artery aneurysm which require no vascular reconstruction.