1. MedPix Medical Image Database COW - Case of the Week Case Contributor: Christopher J Manganello Affiliation: Uniformed Services University

2. MedPix No: 14324 - History Pt Demographics: Age = 69 y.o. Gender = woman 69 y.o. woman with a history of abdominal hernia repair in about 3 years ago. She now complains of a burning sensation in the area of repair, that began about 6 months ago. Downloaded by (-1)

3. MedPix No: 14324 - EXAM & LABS

4. Incidental Hepatic Artery Aneurysm Labeled Image: - Liver (red) - Left renal artery (red outline) - Pancreas (orange) - Right renal vein and IVC (blue outline) - Spleen (red outline) - NOTE: Early in the CT study, after a bolus infusion of contrast, the arterial tree will be brighter than the venous vessels - as shown in this case. The renal cortex enhances in advance of the renal pyramids and collecting system. Downloaded by (-1)

5. Incidental Hepatic Artery Aneurysm Labeled Image: - Liver - red solid - IVC - blue - Aorta - red circle - Pancreas (orange) - Renal cortex - orange w/red outline - NOTE: Early in the CT study, after a bolus infusion of contrast, the arterial tree will be brighter than the venous vessels - as shown in this case. The renal cortex enhances in advance of the renal pyramids and collecting system. Downloaded by (-1)

6. Incidental Hepatic Artery Aneurysm Labeled Image: - Liver - red solid - IVC - blue - Aorta - red circle - Pancreas (orange) - Renal cortex - red outline - - NOTE: Early in the CT study, after a bolus infusion of contrast, the arterial tree will be brighter than the venous vessels - as shown in this case. Downloaded by (-1)

7. Incidental Hepatic Artery Aneurysm Labeled Image: - Liver - red solid - Gall Bladder - green outline - Urinary Bladder - yellow Downloaded by (-1)

8. Incidental Hepatic Artery Aneurysm Labeled Image: - Liver - red solid - Gall Bladder - green outline - Portal vein - blue (horizontal) - Urinary Bladder - yellow - - In the right inguinal/groin area: - vertical blue - femoral vein - vertical red - femoral artery - - NOTE: Early in the CT study, after a bolus infusion of contrast, the arterial tree will be brighter than the venous vessels - as shown in this case. Downloaded by (-1)

9. Incidental Hepatic Artery Aneurysm Hepatic artery aneurysm with calcifications proximal to the origin of the right hepatic, left hepatic, and gastroduodenal arteries Downloaded by (-1)

10. Incidental Hepatic Artery Aneurysm Hepatic artery aneurysm with calcifications proximal to the origin of the right hepatic, left hepatic, and gastroduodenal arteries Downloaded by (-1)

11. Incidental Hepatic Artery Aneurysm Hepatic artery aneurysm with calcifications proximal to the origin of the right hepatic, left hepatic, and gastroduodenal arteries Downloaded by (-1)

12. Incidental Hepatic Artery Aneurysm Hepatic artery aneurysm with calcifications proximal to the origin of the right hepatic, left hepatic, and gastroduodenal arteries Downloaded by (-1)

13. Incidental Hepatic Artery Aneurysm Hepatic artery aneurysm with calcifications proximal to the origin of the right hepatic, left hepatic, and gastroduodenal arteries Downloaded by (-1)

14. Incidental Hepatic Artery Aneurysm Hepatic artery aneurysm with calcifications proximal to the origin of the right hepatic, left hepatic, and gastroduodenal arteries Downloaded by (-1)

15. Incidental Hepatic Artery Aneurysm Hepatic artery aneurysm with calcifications proximal to the origin of the right hepatic, left hepatic, and gastroduodenal arteries Downloaded by (-1)

16. Incidental Hepatic Artery Aneurysm Hepatic artery aneurysm with calcifications proximal to the origin of the right hepatic, left hepatic, and gastroduodenal arteries Downloaded by (-1)

17. Incidental Hepatic Artery Aneurysm Hepatic artery aneurysm with calcifications proximal to the origin of the right hepatic, left hepatic, and gastroduodenal arteries Downloaded by (-1)

18. Incidental Hepatic Artery Aneurysm Hepatic artery aneurysm with calcifications proximal to the origin of the right hepatic, left hepatic, and gastroduodenal arteries Downloaded by (-1)

19. Incidental Hepatic Artery Aneurysm Hepatic artery aneurysm with calcifications proximal to the origin of the right hepatic, left hepatic, and gastroduodenal arteries Downloaded by (-1)

20. Incidental Hepatic Artery Aneurysm Hepatic artery aneurysm with calcifications proximal to the origin of the right hepatic, left hepatic, and gastroduodenal arteries Downloaded by (-1)

21. Incidental Hepatic Artery Aneurysm Hepatic artery aneurysm with calcifications proximal to the origin of the right hepatic, left hepatic, and gastroduodenal arteries Downloaded by (-1)

22. Incidental Hepatic Artery Aneurysm Hepatic artery aneurysm with calcifications proximal to the origin of the right hepatic, left hepatic, and gastroduodenal arteries Downloaded by (-1)

23. Incidental Hepatic Artery Aneurysm Hepatic artery aneurysm with calcifications proximal to the origin of the right hepatic, left hepatic, and gastroduodenal arteries. Downloaded by (-1)

24. Incidental Hepatic Artery Aneurysm Hepatic artery aneurysm with calcifications proximal to the origin of the right hepatic, left hepatic, and gastroduodenal arteries. Downloaded by (-1)

25. Incidental Hepatic Artery Aneurysm Hepatic artery aneurysm with calcifications proximal to the origin of the right hepatic, left hepatic, and gastroduodenal arteries. Downloaded by (-1)

26. Incidental Hepatic Artery Aneurysm Hepatic artery aneurysm with calcifications proximal to the origin of the right hepatic, left hepatic, and gastroduodenal arteries. Downloaded by (-1)

27. Incidental Hepatic Artery Aneurysm Hepatic artery aneurysm with calcifications proximal to the origin of the right hepatic, left hepatic, and gastroduodenal arteries. Downloaded by (-1)

28. Incidental Hepatic Artery Aneurysm Hepatic artery aneurysm with calcifications proximal to the origin of the right hepatic, left hepatic, and gastroduodenal arteries. Downloaded by (-1)

29. Incidental Hepatic Artery Aneurysm Hepatic artery aneurysm with calcifications proximal to the origin of the right hepatic, left hepatic, and gastroduodenal arteries. Downloaded by (-1)

30. Incidental Hepatic Artery Aneurysm Hepatic artery aneurysm with calcifications proximal to the origin of the right hepatic, left hepatic, and gastroduodenal arteries. Downloaded by (-1)

31. Incidental Hepatic Artery Aneurysm Hepatic artery aneurysm with calcifications proximal to the origin of the right hepatic, left hepatic, and gastroduodenal arteries. Downloaded by (-1)

32. Incidental Hepatic Artery Aneurysm Hepatic artery aneurysm with calcifications proximal to the origin of the right hepatic, left hepatic, and gastroduodenal arteries. Downloaded by (-1)

33. Incidental Hepatic Artery Aneurysm Hepatic artery aneurysm with calcifications proximal to the origin of the right hepatic, left hepatic, and gastroduodenal arteries. Downloaded by (-1)

34. Incidental Hepatic Artery Aneurysm Hepatic artery aneurysm with calcifications proximal to the origin of the right hepatic, left hepatic, and gastroduodenal arteries. Downloaded by (-1)

35. Incidental Hepatic Artery Aneurysm Hepatic artery aneurysm with calcifications proximal to the origin of the right hepatic, left hepatic, and gastroduodenal arteries. Downloaded by (-1)

36. Incidental Hepatic Artery Aneurysm Hepatic artery aneurysm with calcifications proximal to the origin of the right hepatic, left hepatic, and gastroduodenal arteries. Downloaded by (-1)

37. Incidental Hepatic Artery Aneurysm Hepatic artery aneurysm with calcifications proximal to the origin of the right hepatic, left hepatic, and gastroduodenal arteries. Downloaded by (-1)

38. Incidental Hepatic Artery Aneurysm Hepatic artery aneurysm with calcifications proximal to the origin of the right hepatic, left hepatic, and gastroduodenal arteries. Downloaded by (-1)

39. Incidental Hepatic Artery Aneurysm Hepatic artery aneurysm with calcifications proximal to the origin of the right hepatic, left hepatic, and gastroduodenal arteries. Downloaded by (-1)

40. Incidental Hepatic Artery Aneurysm Hepatic artery aneurysm with calcifications proximal to the origin of the right hepatic, left hepatic, and gastroduodenal arteries. Downloaded by (-1)

41. FINDINGS 2 cm hepatic artery aneurysm with calcifications, proximal to the origin of the right hepatic, left hepatic, and gastroduodenal arteries. Abdominal hernia repair is intact.

42. DIFFERENTIAL DIAGNOSIS What is your Differential Diagnosis?

43. Diagnosis: Incidental Hepatic Artery Aneurysm Dx Confirmed by: Imaging

44. DISCUSSION Hepatic artery aneurysms account for 20% of splanchnic artery aneurysms with 2:1 male to female ratio. Approximately one third of individuals with hepatic artery aneurysms will also have other splanchnic artery aneurysms. They are also most often discovered in the sixth decade of life. The majority of hepatic artery aneurysms are asymptomatic and found incidentally during imaging for other illnesses, which is the case for this patient. However, if they are symptomatic, patients typically complain of right upper quadrant and epigastric pain, which can be confused with pancreatitis. Furthermore, acute expansion of the aneurysm can cause severe abdominal discomfort and large aneurysms may cause obstructive jaundice. The most serious complication is rupture and can occur in 20% of patients. Currently, treatment is recommended for aneurysms exceeding 2 cm in diameter or if rapidly expanding. Options for treatment including endovascular or open surgical treatment and percutaneous transcatheter obliteration. - - Reference: - Stanley, J. C., Messina, L. M., & Zelenock, G. B. (n.d.). Splanchnic and Renal Artery Aneurysms. Vascular and Endovascular Surgery (Eighth Edition., pp. 695707.e4). Elsevier Inc. doi:10.1016/B978-1-4557-4601-9.00043-6 - - Special Thanks to Drs. Sarah Carpenter, Bennett Davis, and Reilly Zenk