PMC5664268_01
Color Doppler ultrasound demonstrating bidirectional blood flow within an intrahepatic pseudoaneurysm "Ying-Yang sign" (yellow arrow).
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On abdominal duplex US, brisk internal color flow was seen as well as bidirectional blood flow "Ying-Yang sign" (Figure 1).
Axial plane CT angiography of the abdomen early arterial phase demonstrates contrast filling of an intrahepatic pseudoaneurysm (blue arrow) by a prominent right hepatic artery (yellow arrow).
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Immediately adjacent to this mass was an enlarged branch of the right hepatic artery from which a contrast jet was extending into the mass, producing a vascular blush (Figure 2).
Anterior projection digital subtraction angiography demonstrating selective cannulation of right hepatic artery (red arrow). Multiple embolization coils (Tornado 0.08 embolization microcoils and interlocking 2D helical 8 x 20 coils) are filling the right hepatic artery lumen (blue arrow). Few displaced coils and mild residual contrast blush is noted within the aneurysm sac (yellow arrow).
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Subsequent arteriogram demonstrated additional small feeding branches from both the right and left hepatic arteries, which were also embolized (Figure 3).
Postembolization color Doppler ultrasound demonstrating echogenic thrombus occupying the aneurysm sac with near total absence of color flow (yellow arrow).
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Follow-up abdominal ultrasound performed one day after embolization demonstrated near complete thrombosis of the pseudoaneurysm with a large heterogeneous clot in the lumen of the pseudoaneurysm sac (Figure 4).
Axial plane CT of the abdomen without contrast done 1 week after the embolization demonstrates a large collection replacing most of the right hepatic lobe. There is central increased attenuation with layering (yellow arrow) consistent with retracting clot.
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Repeat CTA of the abdomen done 1 week after embolization demonstrated a large organizing hematoma in the right hepatic lobe with no vascular blush (Figures 5 and 6).
Coronal plane CT of the abdomen after embolization with administration of intravenous contrast in portal phase done 1 week after the embolization, demonstrating the collection with no active extravasation. There is a peripheral rim of low attenuation likely related to infracted hepatic parenchyma (yellow arrows).
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Repeat CTA of the abdomen done 1 week after embolization demonstrated a large organizing hematoma in the right hepatic lobe with no vascular blush (Figures 5 and 6).