PMC6066468_01
Multiplanar reformatted images of abdominal CECT: (a) The coronal plan showing ruptured subcapsular HCC (Arrow) and hemoperitoneum (arrowhead). (b) sagittal plan showing tight stenosis at the origin of CA (arrow) due to cMAL.
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Contrast-enhanced CT scan revealed an extravasation of contrast in the arterial phase from the HCC and interruption of the capsule surrounding the lesion confirming the diagnosis of spontaneous rupture (Fig. 1a). The same CT demonstrated non-calcified, short localized stenosis with a characteristic superior hook shape sign at the origin of CA suggesting cMAL (Fig. 1b).
(a) Selective SMA angiogram demonstrating retrograde opacification of the liver arteries through PDA (white arrow) (b) Selective catheterization of the right hepatic artery through the PDA showing hypervascular HCC lesion (white arrow) (c) Post-embolisation angiogram demonstrating succesful occlusion of the right hepatic artery.
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TAE. The SMA angiogram showed retrograde opacification of the hepatic arteries through PDAs confirming the severe stenosis of CA origin (Fig. 2a). PDAs were then selectively catheterized using 2.7F microcatheter and the angiogram showed hypervascular HCC in the right liver lobe (Fig. 2b). TAE of the right hepatic artery using gelatin sponge (Fig. 2c). The follow-up demonstrated improvement in patient's conditions.
PMC6066468_02
Selective SMA angiogram demonstrating: (a) retrograde opacification of hepatic arteries showing irregular and small sized PDA (white arrowhead). (b) Selective cathterization of PDA using microcatheter complicated by arterial dissection and limited extravasation (white arrow). (c) The tip of microcatheter is now at the level of right hepatic artery (white arrowhead). Selective right hepatic angiogram demonstrating extensive contrast extravasation rising from the distal branches of the right liver artery (white arrow). (d) Post embolisation angiogram showing stagnation of forward contrast flow with absence of contrast extravasation denoting successful embolisation.
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The angiogram of SMA was then performed and demonstrated retrograde opacification of the hepatic arteries through PDAs (Fig. 3a). A selective catheterization of the proper hepatic artery was then successfully obtained using 2.7F microcatheter and the angiogram showed extravasation of the contrast media from a peripheral branch of the right hepatic artery (Fig. 3b,c). TAE was then performed using gelatin sponge until arterial occlusion obtained (Fig. 3d).
(a) Five days post embolization Abdominal CECT showing shattered right liver lobe with no contrast extravasation. (b) Sagital plan of multiplanar reformatted images demonstrating severe stenosis of the CA (white arrow) due to cMAL.
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A follow-up CECT was performed 5 days later and showed no more extravasation of contrast media and confirmed the presence of CA stenosis by cMAL (Fig. 4a,b).