Ruptured Intrahepatic Arterial Aneurysm due to Segmental Arterial Mediolysis Treated with Coil Embolization.

A 67-year-old man with a ruptured intrahepatic arterial aneurysm presented with sudden-onset abdominal pain and hemorrhagic shock.

• Contrast-enhanced CT revealed a large hematoma in hepatic segments VI-VII.
• The hematoma was accompanied by capsular rupture and hemoperitoneum.
• This is a single-patient case report.

CT angiography identified a saccular pseudoaneurysm in a posterior segmental branch of the right hepatic artery.

• The imaging also showed a beaded appearance of the right hepatic artery branches, with irregular dilatation and segmental narrowing.
• No inflammatory or atherosclerotic findings were present.

The imaging findings supported a diagnosis of segmental arterial mediolysis (SAM) as the cause of the rupture.

• The diagnosis rested on the beaded arterial pattern and the absence of inflammatory or atherosclerotic changes.
• The lesions were located in intrahepatic branches of the right hepatic artery.

Emergency angiography followed by coil embolization achieved hemostasis.

• The patient was in hemorrhagic shock at presentation.
• The procedure was minimally invasive and used in place of surgery.

Follow-up CT at 5 months showed complete exclusion of the aneurysmal lesions, with no recurrence or new vascular lesions.

• Follow-up duration was 5 months.
• No new vascular lesions were detected on imaging.

The authors conclude that coil embolization may be an effective, minimally invasive option for ruptured intrahepatic SAM lesions.

• The conclusion is drawn from a single case with short (5-month) follow-up.