Arty Fnu, Devarashetty Shreya, Vangala Anoohya, Gaddameedi Sai R, Du Doantrang
Monmouth Medical Center, Long Branch, USA.
Eur J Case Rep Intern Med. 2025 Jul 11;12(8):005606. doi: 10.12890/2025_005606. eCollection 2025.
Hepatic artery aneurysm (HAA) is a rare condition, comprising only 0.1% of all arterial aneurysms, yet it is the most common visceral pseudoaneurysm with a 20% prevalence among such cases. Mycotic HAA in the context of infective endocarditis is uncommon and results from microbial invasion and arterial wall damage.
A 73-year-old woman with coronary artery disease, atrial fibrillation, repaired mitral valve prolapse and on warfarin presented with sudden left lower quadrant abdominal pain. She was hypotensive (BP 60/45 mmHg) and exhibited periumbilical tenderness. Laboratory findings included white blood cell count 18,000 cells/μl, haemoglobin 7.7 g/dl, platelets 1,023,000/μl, aspartate transferase 509 U/l, alanine transaminase 313 U/l and positive SARS-CoV-2. Non-contrast CT of the abdomen/pelvis revealed haemoperitoneum, rectus sheath haematoma and a hypodense hepatic lesion. Contrast-enhanced CT confirmed a left hepatic lobe pseudoaneurysm, supported by Doppler ultrasound. Coil embolisation of the pseudoaneurysm stabilised the patient's haemodynamics. Blood cultures grew , prompting treatment with meropenem and vancomycin due to her prosthetic mitral valve. Transthoracic echocardiogram showed valve vegetation, though a transoesophageal echocardiogram later revealed no vegetations. Follow-up imaging showed a stable thrombosed pseudoaneurysm. The patient remained stable and was transferred for mitral valve replacement. Blood cultures remained negative, but antibiotics were continued for six weeks. Warfarin was resumed without further bleeding.
Mycotic HAAs - though rare - can be life-threatening, especially in anticoagulated patients with prosthetic valves. They often present only upon rupture. Prompt diagnosis, vascular intervention and empirical antibiotic therapy are essential for successful outcomes.
Hepatic artery aneurysm is a rare vascular entity that typically presents with non-specific symptoms, making early diagnosis challenging.One notable aetiology is septic embolisation resulting from infective endocarditis.
肝动脉动脉瘤（HAA）是一种罕见疾病，仅占所有动脉动脉瘤的0.1%，然而它是最常见的内脏假性动脉瘤，在此类病例中的患病率为20%。感染性心内膜炎背景下的霉菌性HAA并不常见，是由微生物侵袭和动脉壁损伤引起的。
一名73岁女性，患有冠状动脉疾病、心房颤动、二尖瓣脱垂修复术后且正在服用华法林，出现突发左下腹疼痛。她血压低（血压60/45 mmHg），脐周有压痛。实验室检查结果包括白细胞计数18,000个/μl、血红蛋白7.7 g/dl、血小板1,023,000/μl、天冬氨酸转氨酶509 U/l、丙氨酸转氨酶313 U/l以及新冠病毒检测呈阳性。腹部/盆腔非增强CT显示腹腔积血、腹直肌鞘血肿和肝脏低密度病变。增强CT证实左肝叶假性动脉瘤，经多普勒超声检查得以佐证。假性动脉瘤的弹簧圈栓塞稳定了患者的血流动力学。血培养生长出[具体细菌名称未给出]，鉴于她的人工二尖瓣，遂用美罗培南和万古霉素进行治疗。经胸超声心动图显示瓣膜赘生物，不过后来经食管超声心动图未发现赘生物。随访影像显示血栓形成的假性动脉瘤稳定。患者病情稳定，转至他处进行二尖瓣置换。血培养仍为阴性，但抗生素持续使用六周。恢复使用华法林，未再出血。
霉菌性HAA虽然罕见，但可能危及生命，尤其是在有人工瓣膜且正在抗凝治疗的患者中。它们通常仅在破裂时才出现。及时诊断、血管介入和经验性抗生素治疗对于取得成功结果至关重要。
肝动脉动脉瘤是一种罕见的血管疾病，通常表现为非特异性症状，早期诊断具有挑战性。一个值得注意的病因是感染性心内膜炎导致的脓毒性栓塞。
