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Arterial phase of contrast enhanced CT. The arrow indicates the point at which flow in the hepatic artery abruptly stops.
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The CT scan showed a large traumatic left diaphragmatic hernia warranting surgical repair and a pancreatic head hematoma with interruption of the common hepatic artery arterial flow (Fig. 1).
Left accessory hepatic artery is visible on the same CT scan.
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In addition, the presence of an accessory left hepatic artery was noted on the arterial phase of the CT (Fig. 2).
A) Hepatic artery pseudoaneurysm lying adjacent to the porta hepatis. Caudate lobe is atrophic. B) Multiple 'bile lakes' affecting exclusively the right lobe of the liver are visible 3 months following initial injury.
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A CT scan was performed and showed a pseudoaneurysm (Fig. 3A) of the proper hepatic artery and multiple cystic biliary dilatations, which selectively affected the right lobe of the liver (Fig. 3B).
Hepatic artery pseudoaneurysm has been embolized. Collaterals to the right hemiliver via the left accessory hepatic artery are visible.
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Angiography showed enlargement of the accessory left hepatic artery with several interlobar communications between the accessory left hepatic artery and the inferior phrenic artery (Fig. 4).
Twelve months from the injury, biliary abnormalities have resolved. Minor abnormality of the vascularization of the periphery of the right liver lobe persists.
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A follow-up CT scan 9 months later showed complete resolution of the intrahepatic bilomas and restitutio ad integrum of the liver (Fig. 5).