Perihepatic caudate lobe haematoma originating from a pancreatic pseudoaneurysm: a diagnostic dilemma

TL;DR

A rare case of a pancreatic pseudoaneurysm causing a liver haematoma is described, highlighting diagnostic challenges and successful treatment.

Contribution

Presents a unique clinical case of a pancreatic pseudoaneurysm manifesting as a perihepatic haematoma and its successful management.

Findings

A 74-year-old man with alcohol-related liver issues had a caudate lobe haematoma initially misdiagnosed as hepatocellular carcinoma.

A pancreatic pseudoaneurysm was later identified and successfully treated with transarterial embolization.

The patient remained recurrence-free for one year after treatment.

Abstract

Despite advances in diagnostic imaging and interventional techniques, pancreatic pseudoaneurysms remain a life-threatening complication of pancreatitis. Presentation varies among patients and may include intra-abdominal, retroperitoneal, or gastrointestinal bleeding and bleeding into the pancreatic or common bile duct. We present a unique case of a 74-year-old man with a history of heavy alcohol consumption who presented with a haematoma surrounding the caudate lobe of the liver. Initially, alcoholic cirrhosis and a ruptured hepatocellular carcinoma were suspected. Therefore, transarterial embolization (TAE) of the caudate branch of the hepatic artery was performed. However, 3 months later, the patient experienced abdominal pain with a lesser sac haematoma and a seemingly interconnected pancreatic cyst. One month later, a pseudoaneurysm appeared in the pancreatic cyst. TAE was successfully performed for the pseudoaneurysm, and the patient showed no signs of recurrence during the 1-year follow-up.

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