PMC6702917_01
(a) Sagittal gray-scale image of the liver demonstrates a 1.5-cm anechoic lesion in the right hepatic lobe (arrow) with minimal through transmission. Also note moderate volume simple perihepatic ascites. (b) Sagittal color Doppler image of the liver shows the anechoic lesion in the right hepatic lobe with yin-yang pattern of internal flow (arrows) and a vascularized neck (arrowhead).(c) Sagittal color Doppler image of the right hepatic lobe lesion demonstrates a high-velocity low-resistance spectral waveform in the neck of the lesion.
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F1
In addition, a 1.5-cm round anechoic lesion was detected in the right hepatic lobe with a "yin-yang" pattern of flow on color Doppler imaging as well as a neck with high-velocity and low-resistance flow [Figure 1].
(a) Axial computed tomography angiography in the arterial phase demonstrate a round 1.5-cm lesion in the right hepatic lobe (arrow) with contrast enhancement that matches the arterial blood pool. The newly placed transjugular intrahepatic portosystemic shunt is also visible (arrowhead). (b) Axial contrast-enhanced computed tomography image in the delayed phase demonstrates a faintly enhancing lesion in the right hepatic lobe (arrow) with enhancement that matches the blood pool. The newly placed transjugular intrahepatic portosystemic shunt is also visible (arrowhead). (c) Volume-rendered image from computed tomography angiography demonstrates the hepatic artery pseudoaneurysm (arrow).
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F2
The lesion showed contrast enhancement which matched the blood pool on the arterial phase and delayed images [Figure 2].
Conventional angiography with selective catheterization of the right hepatic artery demonstrates the enhancing pseudoaneurysm (arrow).
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F3
Conventional angiography was performed using a Renegade Microcatheter (Boston Scientific, Marlborough, MA, USA) confirming the pseudoaneurysm arising from a branch of the right hepatic artery [Figure 3].
Conventional angiography with selective catheterization of the right hepatic artery following percutaneous thrombin injection demonstrates nonopacification of the pseudoaneurysm compatible with complete thrombosis.
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F4
Postthrombin injection conventional angiography showed no visible flow in the aneurysm [Figure 4] and preserved arterial flow to the surrounding hepatic parenchyma.
Axial computed tomography angiography performed the day following thrombin injection confirms complete thrombosis of the pseudoaneurysm which is no longer visible.
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F5
Repeat CTA was performed the following day which confirmed a lack of contrast enhancement within the pseudoaneurysm [Figure 5].