Hepatic aneurysm

Hydralazine (Apresoline, Others) [Antihypertensive/ Vasodilator] Uses Mod-severe HTN CHF (w/ Isordil) Action Peripheral vasodilator Dose Adults. Initial 10 mg PO qid, T to 25 mg qid 300 mg/d max Peds. 0.75-3 mg/kg/24h PO+ q6-12h -l in renal impair, CBC ANA before Caution [C, +] i Hepatic Fxn CAD T tox w/ MAOI, indomethacin, BBs Contra Dissecting aortic aneurysm, mitral valve/rheumatic heart Dz Disp Tabs, inj SE ST E-like synd w/ chronic high, doses SVT following EM route, peripheral neuropathy Interactions T Effects W/ antihypertensives, diazoxide, diuretics, MAOIs, nitrates,... 

Arterial bruit A systolic rushing sound synchronized with the heart beat indicates increased arterial blood flow. This often barely audible sound is easier to discern if one listens for arterial bruit and feels the patient s pulse at the same time. It is sometimes heard where aneurysm or stenosis is present in large arteries (e.g. coeliac artery, hepatic artery) as well as in arteriovenous malformations, highly vascularized liver tumours, pronounced acute alcohol hepatitis, 1-2 days after liver biopsy resulting from temporary arteriovenous fistula, or in twisted arteries in cirrhosis. It is seldom found in healthy persons. (10, 13, 44)... 

Liou, T.-C., Ling, C.-C., Pang, K.-K. Liver abscess concomitant with hemobilia due to rupture of hepatic artery aneurysm a case report. Hepato-Gastroenterol. 1996 43 241-244... 

Aneurysm of the hepatic artery Arteriovenous fistula Calcification of the hepatic artery Cavernous haemangioma Echinococcus cysts (s. fig. 25.18)... 

While aneurysms of the hepatic arteries are in themselves rare, they nevertheless constitute 20% of all an-... 

Congenital anomalies and aneurysms in the hepatic arteries are very rare. (129) Acquired aneurysms are the result of vessel wall damage, injuries or inflammatory processes. (I3l, 133, 136) Pseudoaneurysms may occur after acute pancreatitis and the formation of pseudocysts. (135) (s. tab. 39.5)... 

Once detected, an aneurysm of the hepatic artery requires immediate treatment. Up to a certain size, intrahepatic aneurysms are treated by angiographic embolization. Coagulation by means of direct thrombin injection has also been described. (130) Larger aneurysms are treated by vascular surgery (ligation, vascular reconstruction, resection). (132, 137)... 

Erdem, C.Z., Erdem, L.O., Comert, M., Ustnndag, Y., Gundogu, S. Multiple intra-hepatic portal vein aneurysms — findings on magnetic resonance angiography. Clin. Radiol. 2003 58 899—901... 

Countryman, D., Norwood, S., Raster, D., Torma, M., Andrassy, R. Hepatic artery aneurysm report of an unusual case and review of the literature. Amer. Surg. 1983 49 51—54... 

Ferrari, A.R, Ferreira, J.RA., de Panio, GA., della Libera, E. Hemo-bilia caused by a mycotic aneurysm of the hepatic artery treated by enbucrilate injection during ERCP (case report). Gastrointest. Endosc. 2003 57 260 - 263... 

G. Hepatic artery aneurysm, an unusual cause of obstructive jaundice MR cholangiography findings. Abdom. Imag. 2003 28 835-837... 

Van den Steen, G., Michielsen, R, van Outryve, M., Corthouts, B., de Backer, A., D Archambeau, O., van den Brande, F., Ysebaert, D. Asymptomatic aneurysm of the hepatic artery. Management options (case report). Acta Gastro-Enterol. Belg. 2003 66 298 - 302... 

Zachary, K., Geier, S., Pellecchia, C, Irwin, G. Jaundice secondary to hepatic artery aneurysm radiological appearance and clinical features. Amer. J. Gastroenterol. 1986 81 295 - 298... 

Chronic infection with C burnetii is usually manifested by infective endocarditis, which is also the most severe complication of Q fever. In addition, a report73 from France of 92 cases published in 1993 also listed hepatitis, infected vascular prostheses and aneurysms, osteomyelitis, pulmonary infection, cutaneous infection, and an asymptomatic form. In addition, 7 of the 92 patients described in this report experienced fever only. Also noted was the observation that although 81% of patients had an identifiable risk factor, only 31% lived in a rural area. In addition, some form of immunodeficiency was observed in 20% of the patients, raising the possibility that chronic Q fever occurs as a result of reactivation of latent infection.73 Inflammatory pseudotumor of the lung as a chronic complication of Q fever has also been reported.74,75... 

Fig.7.9a,b. A 52-year-old woman with a recent history of gall stone pancreatitis was admitted with further abdominal pain. A CECT scan suggested an aneurysm of uncertain origin. Angiography revealed a true (Type la) aneurysm of an aberrant right hepatic artery (a). CECT had revealed a patent portal vein and so proximal and distal coil embolization was performed (b). There were no further complications and the patient is alive and well at 36 months... 

There is one further indication for thrombin occlusion of pancreatitis associated visceral aneurysms. Where the portal vein has occluded as a complication and the patient has a proximal splenic or gastroduodenal aneurysm, the proximal and distal coil embolization of which could compromise the hepatic arterial supply to the liver causing liver infarction, thrombin injection maybe a safer technique [29]. 

De Cristofaro R et al. (1992) Selective arterial embolization in the treatment of aneurysmal bone cyst and angioma of bone. Skeletal Radiol 21 523-527 Diamandidou E et al. (1998) Two-phase study of hepatic artery vascular occlusion with microencapsulated cisplatin in patients with liver metastases from neuroendocrine tumors. AJR Am J Roentgenol 170 339-344 Dick HM et al. (1979) Adjuvant arterial embolization in the treatment of benign primary bone tumors in children. Clin Orthop 139 133-341... 

Kemeny N et al. (1999) Hepatic arterial infusion of chemotherapy after resection of hepatic metastases from colorectal cancer. N Engl J Med 341 2039-2048 Kim YH et al. (1999) Selective hepatic arterial chemoembolization for liver metastases in patients with carcinoid tumor or islet cell carcinoma. Cancer Invest 17 474-478 Konno T (1990) Targeting cancer chemotherapeutic agents by use of lipiodol contrast medium. Cancer 66 1897-1903 Konya A,Szendroi M (1992) Aneurysmal bone cysts treated by superselective embolization. Skeletal Radiol 21 167-172 Kramer SC et al. (1999) Interventional treatment of hemorrhages in advanced cervical carcinoma. Radiologe 39 795-798... 

Sakai H, Urasawa K, Oyama N, Kitabatake A (2004) Successful covering of a hepatic artery aneurysm with a coronary stent graft. Cardiovasc Intervent Radiol 27 274-277... 

Fig. 8.3. a Celiac angiogram in a patient with portal hypertension demonstrating a distal splenic artery aneurysm, b Celiac angiogram from another patient with multiple splenic aneurysms associated with portal hypertension who has undergone liver transplantation. Note the large hepatic pseudoaneurysm just medial to the upper pole of the right kidney, c Selective common hepatic artery injection in the patient from b... 

Hepatic artery aneurysms comprise 20% of all visceral aneurysms [4, 10-12]. Eighty percent are extrahepatic and 20% are intrahepatic. The majority affect the common hepatic artery. Males are affected... 

Mycotic aneurysms from bacterial endocarditis were initially the most common cause of hepatic artery aneurysm [11]. However, traumatic and iatrogenic causes are likely the most common etiology today. Medial degeneration and atherosclerotic changes have also been implicated. However, atherosclerosis is more likely the result rather than the cause of the... 

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