PMC5041375_01
A 61-year-old man with shock after liver biopsy. Contrast enhanced computed tomography of the abdomen demonstrates massive hemoperitoneum and active contrast extravasation from the anterior surface of segment 5 of the liver (arrow).
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F1
Urgent contrast enhanced computed tomography (CT) revealed large intraperitoneal hemorrhage and contrast extravasation from biopsy site [Figure 1].
Celiac angiogram of the patient showed marked stenosis and tortuous course of the celiac trunk, common and main hepatic arteries, and the intrahepatic arteries (arrows).
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F2
Urgent trans arterial embolization via femoral artery approach attempted but failed due to marked stenosis at origin of the celiac trunk [Figure 2]. Tortuous and stenosed hepatic arteries were also noted on angiogram [Figure 2].
Gray scale sagittal ultrasound image of liver with color flow Doppler demonstrates active bleeding from the segment 5 of liver corresponding to the biopsy site (arrow).
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F3
Urgent US-guided percutaneous microwave ablation was performed after localization of active bleeding site by color Doppler US [Figure 3]. Under US guidance, microwave needle was inserted into the bleeding zone percutaneously through subcostal approach [Figure 4].
Ultrasound-guided percutaneous microwave ablation performed with microwave needle targeted at the bleeding zone at segment 5 of the liver (arrow) demonstrates post ablation changes with cessation of bleeding.
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F4
Urgent US-guided percutaneous microwave ablation was performed after localization of active bleeding site by color Doppler US [Figure 3]. Under US guidance, microwave needle was inserted into the bleeding zone percutaneously through subcostal approach [Figure 4].