J Korean Soc Radiol.  2017 Jan;76(1):25-29. 10.3348/jksr.2017.76.1.25.

Gelatin Sponge Particle Embolization of Spontaneously Ruptured Intrahepatic Arterial Aneurysms in a Patient with Polyarteritis Nodosa: A Case Report

• Seol MJ
• Noh KH
• Kim YJ
• Jeon DS

• KMID: 2365048
• DOI: http://doi.org/10.3348/jksr.2017.76.1.25

Abstract

Multiple intrahepatic arterial aneurysms and spontaneous aneurysmal rupture associated with polyarteritis nodosa leading to hemoperitoneum are extremely rare occurrences, but the conditions can be life-threatening if left untreated because of the risk of massive hemorrhage. We report a case of a high-risk surgical patient with polyarteritis nodosa complicated by spontaneous rupture of multiple intrahepatic arterial aneurysms. He was initially treated with emergency gelatin sponge particle embolization, followed by maintenance steroid treatment. Complete resolution of intrahepatic arterial aneurysms was observed at follow-up.

MeSH Terms

Aneurysm*
Angiography
Embolization, Therapeutic
Emergencies
Follow-Up Studies
Gelatin*
Hemoperitoneum
Hemorrhage
Hepatic Artery
Humans
Multidetector Computed Tomography
Polyarteritis Nodosa*
Porifera*
Rupture
Rupture, Spontaneous
Gelatin

Figure

• 

  Fig. 1 Spontaneously ruptured intrahepatic arterial aneurysms in a 32-year-old man with polyarteritis nodosa who presented with a sudden-onset epigastric pain. A. Axial contrast-enhanced CT shows an intrahepatic hematoma measuring approximately 10 cm in diameter in segment IV and extravasation of the contrast (arrow). B. Multifocal small contrast extravasations (arrows) on the surface of the liver, and a subcapsular hematoma exceeding 3 cm in thickness with a large amount of hemoperitoneum are seen. C. A selective common hepatic angiogram shows multiple aneurysms of varying sizes (arrows) with multifocal vascular ectasia and stenoses (arrowhead). Note the active extravasation of the contrast from the ruptured left medial hepatic artery (curved arrow), presumed to be extravasation of the contrast observed in segment IV on the CT scan.

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