PMC5467703_01
Endoscopic retrograde cholangiopancreatography image shows severe intra and extrahepatic biliary ductal dilatation starting at the proximal common bile duct with tapered narrowing (arrow) due to extrinsic compression from the hepatic artery aneurysm.
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This revealed a CBD stricture approximately 2.5 cm in length at the level of cystic duct takeoff with massive biliary dilation proximally (Figure 1).
Contrast-enhanced axial computed tomographic image of the abdomen shows a contrast-filled rounded structure (arrow) adjacent to the hepatic hilum compressing the common bile duct (arrowhead). This finding is consistent with a hepatic artery aneurysm. There are intra- and extrahepatic biliary ductal dilatation secondary to an extrinsic compression from the hepatic artery aneurysm.
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HAA compressing the CBD (Figures 2 and 3). He then underwent coil embolization of the hepatic artery (Figure 4A and B).
Three-dimensional reconstruction of Figure 2. CBD indicates common bile duct.
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HAA compressing the CBD (Figures 2 and 3). He then underwent coil embolization of the hepatic artery (Figure 4A and B).
Selective digital subtraction angiography of the hepatic artery (A) before and (B) after embolization. The aneurysmal dilatation of the common hepatic artery is clearly delineated (A, arrow). Incidentally noted a plastic biliary stent (A, arrowhead). Follow-up image after multiple metallic coil placement (B, arrow) shows no contrast material filling the aneurysmal sac.
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HAA compressing the CBD (Figures 2 and 3). He then underwent coil embolization of the hepatic artery (Figure 4A and B).
Endoscopic retrograde cholangiopancreatography (ERCP) sagittal view approximately 6 weeks after first ERCP and hepatic artery embolization demonstrates improvement of the intra- and extrahepatic biliary ductal dilatation (arrow).
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This revealed improvement in the biliary tree dilatation (Figure 5).
Contrast-enhanced axial computed tomographic image of the abdomen after hepatic artery aneurysm embolization (arrow). Coiling material produces metallic artifacts limiting the evaluation of the surrounding structures. Poorly characterized biliary system dilatation is improved.
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However, poorly characterized biliary system dilatation was improved (Figure 6).
Ultrasound image of the common bile duct (CBD) performed 18 months after hepatic artery embolization shows a normal caliber (0.47 cm) CBD (arrow).
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Ultrasound performed at the same time revealed a normal caliber (0.47 cm) CBD (Figure 7).