case_images: PMC5664268_01
case_images: Color Doppler ultrasound demonstrating bidirectional blood flow within an intrahepatic pseudoaneurysm "Ying-Yang sign" (yellow arrow).
case_images: CRIVAM2017-4658065.001.jpg
case_images: PMC5664268_01_CRIVAM2017-4658065.001.jpg
case_images: fig1
case_images: On abdominal duplex US, brisk internal color flow was seen as well as bidirectional blood flow "Ying-Yang sign" (Figure 1).
case_images: Axial plane CT angiography of the abdomen early arterial phase demonstrates contrast filling of an intrahepatic pseudoaneurysm (blue arrow) by a prominent right hepatic artery (yellow arrow).
case_images: CRIVAM2017-4658065.002.jpg
case_images: PMC5664268_01_CRIVAM2017-4658065.002.jpg
case_images: fig2
case_images: Immediately adjacent to this mass was an enlarged branch of the right hepatic artery from which a contrast jet was extending into the mass, producing a vascular blush (Figure 2).
case_images: Anterior projection digital subtraction angiography demonstrating selective cannulation of right hepatic artery (red arrow). Multiple embolization coils (Tornado 0.08 embolization microcoils and interlocking 2D helical 8 x 20 coils) are filling the right hepatic artery lumen (blue arrow). Few displaced coils and mild residual contrast blush is noted within the aneurysm sac (yellow arrow).
case_images: CRIVAM2017-4658065.003.jpg
case_images: PMC5664268_01_CRIVAM2017-4658065.003.jpg
case_images: fig3
case_images: Subsequent arteriogram demonstrated additional small feeding branches from both the right and left hepatic arteries, which were also embolized (Figure 3).
case_images: Postembolization color Doppler ultrasound demonstrating echogenic thrombus occupying the aneurysm sac with near total absence of color flow (yellow arrow).
case_images: CRIVAM2017-4658065.004.jpg
case_images: PMC5664268_01_CRIVAM2017-4658065.004.jpg
case_images: fig4
case_images: Follow-up abdominal ultrasound performed one day after embolization demonstrated near complete thrombosis of the pseudoaneurysm with a large heterogeneous clot in the lumen of the pseudoaneurysm sac (Figure 4).
case_images: Axial plane CT of the abdomen without contrast done 1 week after the embolization demonstrates a large collection replacing most of the right hepatic lobe. There is central increased attenuation with layering (yellow arrow) consistent with retracting clot.
case_images: CRIVAM2017-4658065.005.jpg
case_images: PMC5664268_01_CRIVAM2017-4658065.005.jpg
case_images: fig5
case_images: Repeat CTA of the abdomen done 1 week after embolization demonstrated a large organizing hematoma in the right hepatic lobe with no vascular blush (Figures 5 and 6).
case_images: Coronal plane CT of the abdomen after embolization with administration of intravenous contrast in portal phase done 1 week after the embolization, demonstrating the collection with no active extravasation. There is a peripheral rim of low attenuation likely related to infracted hepatic parenchyma (yellow arrows).
case_images: CRIVAM2017-4658065.006.jpg
case_images: PMC5664268_01_CRIVAM2017-4658065.006.jpg
case_images: fig6
case_images: Repeat CTA of the abdomen done 1 week after embolization demonstrated a large organizing hematoma in the right hepatic lobe with no vascular blush (Figures 5 and 6).