Crisis Averted: Hepatic Artery Pseudoaneurysm Mimicking a Klatskin Tumor

Introduction: Classically, hepatic artery pseudoaneurysms (HAPs) arise secondary to trauma or iatrogenic causes. In this case, the patient had no past surgeries or trauma to indicate the mass seen upon imaging was a pseudoaneurysm, hence the diagnosis as a neoplasm. If interventional radiology (IR) had not been consulted prior to biopsy, the pseudoaneurysm would have ruptured during the procedure. In literature, HAPs are discussed in reference to recent liver transplant, never in an otherwise healthy patient. Case presentation: A 71-year-old Caucasian male with no significant past medical history presented with painless jaundice and elevated serum bilirubin. Non-contrast CT showed a 4-cm mass in the hepatic hilum and dilitation of the intrahepatic bile ducts. The primary diagnostic consideration was neoplasm with cholangiocarcinoma (possible Klatskin tumor). Deviation from expected: This case is unique because the HAP presented with no past or recent trauma and painless jaundice, leading to its false initial diagnosis of a neoplasm. Discussion: IR was consulted for possible CT guided percutaneous biopsy. Prior to biopsy, IR ordered a CT of the abdomen with contrast and an ultrasound (US) of the abdomen with Doppler. These exams revealed flow within the mass and HAP was diagnosed. Biopsy was cancelled, and potential massive hemorrhage was averted. IR performed an angiogram and endovascular coil embolization. Conclusion: This case demonstrates the possibility of a HAP arising spontaneously, with no apparent etiology. While it is significant to both hepatology and interventional radiology, it also is an example of how collaboration averted a crisis. Grants: Non