Spontaneous resolution of asymptomatic hepatic pseudoaneurysm post radiofrequency ablation

A case of hepatocellular carcinoma with pseudoaneurysm formation upon lenvatinib administration

A 79-year-old man received treatment for multiple intrahepatic hepatocellular carcinoma with atezolizumab + bevacizumab. However, he developed lower back pain attributed to spinal metastases upon tumor enlargement; thus, he was admitted to our hospital for a change from atezolizumab + bevacizumab to lenvatinib and radiation therapy for the spinal metastases. On the 11th day after starting lenvatinib treatment, a pulsatile aneurysm appeared in the tumor, detected using abdominal ultrasonography Micro B-flow imaging, which visualized blood flow at a high frame rate; this was diagnosed as a pseudoaneurysm. The patient refused treatment for the pseudoaneurysm; therefore, he was carefully followed up. Fortunately, the pseudoaneurysm disappeared on the 17th day. One month later, the tumor had become completely necrotic. Lenvatinib demonstrated effectiveness in inhibiting angiogenesis in the tumor, as evidenced by a decrease in tumor blood flow. This case report suggests that pseudoaneurysm formation within the tumor occurs early after the administration of lenvatinib; thus, clinicians must be aware of the potential risk of pseudoaneurysm rupture.

Mycotic pseudoaneurysm of the hepatic artery as a complication of radiofrequency ablation of hepatic metastases

Image-guided radiofrequency ablation is frequently used to treat small hepatocellular carcinoma and metastases. Complications associated with this thermal-based technology for liver cancers arise via direct mechanical injury by the electrodes or collateral thermal damage to surrounding structures. This case report describes an unusual presentation of hepatic arterial mycotic pseudoaneurysm as melaena after percutaneous image-guided radiofrequency ablation for liver metastases in a patient with a previous surgical history of hepaticojejunostomy for cholangiocarcinoma. The patient had a lifesaving procedure to treat the hepatic pseudoaneurysm with transarterial glue embolization.

Percutaneous ethanol ablation of intrahepatic arterial pseudoaneurysm: A case report

Hepatic arterial pseudoaneurysm is a rare but potentially fatal condition that requires prompt management. We report a case of hepatic arterial pseudoaneurysm developed after radiofrequency ablation of a hepatocellular carcinoma. The patient was successfully treated with percutaneous absolute ethanol injection under ultrasound guidance. Follow-up studies with ultrasound and computed tomography for 2 years after treatment revealed no evidence of local recurrence of hepatocellular carcinoma and of the pseudoaneurysm.