Congenital hepatic artery aneurysm simulating pancreatic carcinoma

Evolving Diagnostic and Therapeutic Options for Visceral Artery Aneurysms

BACKGROUND

Visceral artery aneurysms (VAAs) are associated with a very high mortality rate when ruptured and may present as a surgical emergency. Due to their rarity and varying pathophysiology, literature concerning the optimal management of VAAs is limited. This review evaluates the evolving management options for VAAs with a focus on open and endovascular repair.

METHODS

A combination of databases including OVID, PubMed and Medline were used to perform a literature search. Search terms employed include 'visceral artery aneurysms', 'angiography', '3D-volumetric rendering', 'management', 'open repair' and 'endovascular repair', amongst others.

RESULTS

3D modelling in conjunction with existing diagnostic techniques, such as computed tomography and angiography, may improve diagnostic sensitivity. The literature surrounding operative management of VAAs highlights the effectiveness of endovascular repair for anatomically suitable aneurysms. Advances in endovascular technologies may expand the type and number of aneurysms amenable to catheter-based treatment approaches. For aneurysms not amenable to endovascular treatment, or those with an emergency indication, open repair remains an appropriate management choice.

CONCLUSION

Although rare, VAAs pose a high mortality risk, especially when ruptured. Practical limitations that restrict current operative approaches may be overcome by recent developments including novel neurointerventional techniques that have been applied in VAA management.

Peripancreatic masses that simulate pancreatic disease: spectrum of disease and role of CT

A number of entities can simulate pancreatic disease at computed tomography (CT), which may lead to misdiagnosis. Common pitfalls include peripancreatic lesions of the foregut, adrenal gland, and kidney as well as disease of the mesentery and neurovascular structures. Optimal design and application of multi-detector row CT protocols with multiplanar reformation and maximum-intensity-projection and volume-rendering postprocessing improves the specificity of image interpretation. In most cases, helical CT is highly accurate for distinguishing primary disease of the pancreas from adjacent disease, although there are cases in which the differential diagnosis is more challenging and the potential for misdiagnosis still exists. Familiarity with some of the entities that can simulate pancreatic disease, careful attention to scanning protocol and contrast material administration, use of the full potential of multi-detector row CT data sets, and judicious application of postprocessing tools may help avoid some of the pitfalls caused by peripancreatic lesions.

[Rupture of an aneurysm of the common hepatic artery with pancreatic necrosis]

A male patient known to have hemophilia A was operated on twice (1990, 1991) in the Department of Surgery, University Hospital, Zurich, first because of severe intraabdominal hemorrhage from a liver artery aneurysm, and then because of a ruptured common hepatic artery aneurysm. The second surgical intervention revealed necrosis of the head and body of the pancreas. We consider that the pancreatic necrosis had resulted from the aneurysm, in view of the patient's history of silent pancreatitis and the uncomplicated postoperative course. Immediate reconstruction of the common hepatic artery aneurysm (in the presence of an occluded gastroduodenal artery) was performed with saphenous vein interposition. Because visceral aneurysms may be multiple, further aneurysms must be sought at the time of the first diagnosis. Elective surgery is the method of choice, because 40-80% of visceral aneurysms rupture spontaneously, with a high mortality rate. The mortality rate for elective surgery is now low.

Radiological evaluation of hepatic artery aneurysms

The authors report 4 cases of hepatic artery aneurysm confirmed by computed tomography, sonography, angiography, and/or surgery. Three aneurysms involved the right hepatic artery and 1 involved the common hepatic artery. Two cases were treated with surgery, and the other 2 cases with transcatheter embolization. The clinical and radiological features of this entity are described together with a review of the pertinent literature.

Hepatic artery aneurysm: CT and MR features

The authors report a case of common hepatic artery aneurysm diagnosed by computed tomography (CT) and magnetic resonance (MR). Features of both techniques are described and discussed. The surgical and radiologic literature is reviewed.