PMC7395560_01
71-year-old male with a recent cholecystectomy who presents with abdominal pain (a) axial contrast-enhanced CT of the abdomen and pelvis demonstrates a large abscess in the right hepatic lobe (arrow). (b) Coronal contrast-enhanced CT of the abdomen and pelvis (right image) demonstrates another large abscess at the base of the right hepatic lobe (arrow) with a medial smaller abscess (arrowhead).
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F1
Contrast-enhanced CT of the abdomen and pelvis (CT A/P) demonstrated multiple large subscapular hepatic abscesses [Figure 1a and b].
71-year-old male with a recent cholecystectomy complicated by multiple abdominal abscesses who presents with abdominal pain. (a) Axial contrast-enhanced CT of the abdomen and pelvis (left image) demonstrates placement of drainage catheter in the right hepatic lobe abscess (arrow). (b) Coronal contrast- enhanced CT of the abdomen and pelvis (right image) demonstrates a drainage catheter in the inferior hepatic abscess (arrow) with interval growth of the more medial abscess (arrowhead).
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F2
Drainage catheters were subsequently placed in two abscesses [Figure 2a and b].
71-year-old male with a recent cholecystectomy complicated by multiple abdominal abscesses who presents with abdominal pain. Coronal contrast-enhanced CT of the Abdomen and pelvis demonstrates a subtle aneurysmal dilatation of the proper hepatic artery (arrow) concerning for a mycotic aneurysm.
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F3
On repeat, contrast-enhanced CT A/P demonstrated new focal dilatation in the right hepatic artery concerning the development of a mycotic pseudoaneurysm [Figure 3].
71 year old male with a recent cholecystectomy complicated by multiple abdominal abscesses who presents with worsening abdominal pain. Angiogram of the hepatic artery demonstrating an aneurysm at the distal hepatic artery (arrow) with no evidence of active bleeding.
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F4
A visceral angiogram was performed, which demonstrated aneurysmal dilation at the distal portion of the proper hepatic artery measuring approximately 1.5 cm [Figure 4].
71 year old male with a known mycotic pseudoaneurysm of the hepatic artery presents with worsening abdominal pain. Axial contrast-enhanced image of the abdomen demonstrates interval growth of the mycotic aneurysm (arrow).
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F5
He returned to the ED approximately a week later with worsening of his symptoms, and a repeat CT A/P demonstrated a new fluid collection within the porta hepatis with interval enlargement of the pseudoaneurysm [Figure 5].
71-year-old male with a known mycotic pseudoaneurysm of the hepatic artery who recently coded on multiple vasopressors. (a) Angiogram at the celiac artery demonstrates no distal flow to the hepatic artery with large active hemorrhage (arrow). (b) Microcatheter was advanced to the distal hepatic artery (arrowhead), with angiogram demonstrating massive active hemorrhage (arrow).
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F6
An angiogram was performed demonstrating frank extravasation just after the origin of the proper hepatic artery [Figure 6].
71-year-old male with a known mycotic pseudoaneurysm of the hepatic artery who recently coded on multiple vasopressors. Angiogram demonstrating multiple coils deployed into the gastroduodenal and proximal proper hepatic artery. Despite the placement of the coils, there is still active contrast extravasation from the aneurysm (arrow).
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F7
Despite the placement of multiple coils, there was continued visualization of active hemorrhage [Figure 7].
71-year-old male with a known mycotic pseudoaneurysm of the hepatic artery who recently coded on multiple vasopressors. After the direct administration of thrombin through the catheter, an angiogram of the celiac artery demonstrates successful embolization and no further extravasation (arrow).
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F8
The microcatheter was then removed, the 5 French catheters was aspirated and flushed, and a repeat angiogram through the 5 French catheters demonstrated successful embolization [Figure 8].