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Hepatic Artery Pseudoaneurysms in Adult Living-Donor Liver Transplantation: Efficacy of CT and Doppler Sonography

Hyoung Jung Kim1,2, Kyoung Won Kim1, Ah Young Kim1, Tae Kyoung Kim1, Jae Ho Byun1, Hyung Jin Won1, Yong Moon Shin1, Pyo Nyun Kim1, Hyun Kwon Ha1, Sung Gyu Lee3 and Moon-Gyu Lee1

1 Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap-dong, Songpa-ku, Seoul 138-736, Korea.
2 Department of Diagnostic Radiology, Kyung Hee University Hospital, Seoul, Korea.
3 Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.



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  		Fig. 1A. —63-year-old man with hepatic artery pseudoaneurysm detected on Doppler sonography. Color Doppler sonogram at postoperative day 7 shows periportal round structure with turbulent flow (white arrow).

 


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  		Fig. 1B. —63-year-old man with hepatic artery pseudoaneurysm detected on Doppler sonography. Sudden hypotension developed next day. Hepatic artery phase CT scan shows pseudoaneurysm (black arrow), extravasation of contrast material (white arrow), and acute hematoma adjacent to graft.

 


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  		Fig. 1C. —63-year-old man with hepatic artery pseudoaneurysm detected on Doppler sonography. Maximum-intensity-projection image shows pseudoaneurysm (white arrow) at hepatic artery anastomosis site.

 


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  		Fig. 1D. —63-year-old man with hepatic artery pseudoaneurysm detected on Doppler sonography. Hepatic arteriogram shows similar appearance as seen on maximum-intensity-projection image.

 


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  		Fig. 2A. —46-year-old man with mycotic pseudoaneurysm. Maximum-intensity-projection image at postoperative day 14 shows no definite pseudoaneurysm.

 


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  		Fig. 2B. —46-year-old man with mycotic pseudoaneurysm. Sudden hypotension developed at postoperative day 19. Two consecutive hepatic artery phase images show pseudoaneurysm (black arrow, C) and extravasation of contrast material (white arrow, C). Emergency surgery was performed to excise pseudoaneurysm and to reconstruct hepatic artery.

 


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  		Fig. 2C. —46-year-old man with mycotic pseudoaneurysm. Sudden hypotension developed at postoperative day 19. Two consecutive hepatic artery phase images show pseudoaneurysm (black arrow, C) and extravasation of contrast material (white arrow, C). Emergency surgery was performed to excise pseudoaneurysm and to reconstruct hepatic artery.

 


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  		Fig. 3A. —50-year-old woman with small hepatic artery pseudoaneurysm. Hepatic artery phase CT scan at postoperative day 10 shows segmental low-density lesion in left graft (white arrows). Hepatic artery pseudoaneurysm is not seen.

 


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  		Fig. 3B. —50-year-old woman with small hepatic artery pseudoaneurysm. Hepatic arteriogram shows small pseudoaneurysm (black arrow) and narrowing of anastomosis site between hepatic artery of graft and left gastric artery of recipient.

 


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  		Fig. 4A. —55-year-old man with hepatic artery pseudoaneurysm and partial thrombosis. Serial hepatic artery phase CT scans at postoperative day 15 show hepatic artery pseudoaneurysm (black arrow, A) of proximal common hepatic artery and partial thrombosis (white arrow, B).

 


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  		Fig. 4B. —55-year-old man with hepatic artery pseudoaneurysm and partial thrombosis. Serial hepatic artery phase CT scans at postoperative day 15 show hepatic artery pseudoaneurysm (black arrow, A) of proximal common hepatic artery and partial thrombosis (white arrow, B).

 


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  		Fig. 4C. —55-year-old man with hepatic artery pseudoaneurysm and partial thrombosis. Volume-rendering image shows origin of pseudoaneurysm (white arrow) and narrowing of common hepatic artery.

 


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  		Fig. 4D. —55-year-old man with hepatic artery pseudoaneurysm and partial thrombosis. Hepatic arteriogram has similar appearance to that seen on volume-rendering image.

 

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