PMC6180884_01
Portal venous phase CT scan. (a) Thick white arrow points to liver abscess; thin white arrow points to high density within the gallbladder. (b) Arterial phase 1 week later (arrow denotes the pseudoaneurysm).
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fig1
However, his condition deteriorated with worsening sepsis and a repeat CT scan demonstrated increasing dimensions of the liver abscess and a high density focus within the gallbladder neck, at this point thought to represent a calculus (Figure 1a). A CT angiogram demonstrated a 26 x 17 mm pseudoaneurysm arising from the cystic artery and haemobilia (Figure 1b).
Arterial phase maximum intensity projection of the pseudoaneurysm (denoted by the white arrow).
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fig2
Arterial anatomy showed a cystic artery that originated from the right hepatic artery as a branch of the superior mesenteric artery (Figure 2).
Selective catheterization of the cystic artery. Arrow indicates the pseudoaneurysm.
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fig3
The pseudoaneurysm was then embolized by instilling a mixture of 2 : 4 cyanoacrylate and  lipiodol (Figure 3) into the cystic artery as an instant embolic agent and accept the risk of gallbladder necrosis.