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Figure 7f. Bleeding from a pseudoaneurysm into a hepatic abscess in a 70-year-old man. The patient had a history of Billroth II–type gastrectomy, right hepatic lobectomy, and radiation therapy for a portal vein tumor thrombus. RF ablation was performed for recurrent hepatocellular carcinoma in segment III. (a) US image, obtained soon after RF ablation, shows an inhomogeneous and relatively hyperechoic area that corresponds to the ablated area (arrowheads). (b, c) Follow-up US image (b) and CT scan (c), obtained 5 months after RF ablation, show a biloma (arrow) in the ablated area just anterior to the proper hepatic artery (arrowhead in c), with no evidence of pseudoaneurysm. (d) Unenhanced CT scan, obtained when the patient was admitted to the hospital for fever and melena 13 months after RF ablation, shows an area of high attenuation (arrow) suggestive of hemorrhage in an abscess derived from the biloma. (e) Subsequent angiogram helps to confirm a pseudoaneurysm of the proper hepatic artery (arrow). (f ) Follow-up angiogram obtained immediately after isolation of the pseudoaneurysm with fibered platinum embolization coils (arrowheads) shows that bleeding has stopped. No complication associated with embolization was documented. The abscess was controlled with antibiotics, without drainage.
