PMC7283991_01
Time course of liver cysts on contrast-enhanced computed tomography until after the first percutaneous catheter drainage in an 84-year-old man. A, Contrast-enhanced computed tomography on admission. Small, infected cysts (white arrow) presenting with increased contrast enhancement of the wall and fat stranding around the cysts on the surface of the body. B, Seven days before the first percutaneous catheter drainage. Presence of the giant cyst is confirmed (asterisk). C, After the first percutaneous catheter drainage, the size of the giant cyst decreased (asterisk).
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We considered undertaking PCD to the infected small cyst (Fig. 1A) as soon as possible after the admission; however, we could not carry out the procedure by the trans-hepatic approach because the infected cyst was small and situated in the surface of the body. Another giant cyst enlarged and compressed the bile duct (Fig. 1B). Following the PCD, his condition improved, and the size of the giant cyst decreased (Fig. 1C).
Contrast-enhanced computed tomography carried out 2 days after the second percutaneous catheter drainage of infected liver cysts in an 84-year-old man. A, Abdominal hematoma (white arrowhead). Extravasation of a branch of the right internal mammary artery (red arrow). B, 3-D computed tomography image showing extravasation at the branch of the distal internal mammary artery (white arrowhead).
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Contrast-enhanced CT revealed an abdominal hematoma around the drain catheter and extravasation of the distal IMA; therefore, we diagnosed the patient with IMA injury due to PCD (Fig. 2).
Right internal mammary artery angiogram undertaken before and after percutaneous coil embolization in an 84-year-old man with internal mammary artery injury after ultrasound-guided percutaneous catheter drainage for liver cyst infection. A, Selective right internal mammary artery angiogram at anteroposterior view. White arrowheads show extravasation of right distal internal mammary artery. B, Angiogram after percutaneous coil embolization. Extravasation was completely sealed by implantation of four coils.
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Selective IMA angiography revealed extravasation of the distal segment of the right IMA (Fig. 3A). A final angiography showed that the perforation was completely sealed (Fig. 3B).