Summary
Background
Aneurysms of visceral arteries are rare, but in case of rupture, they are potentially life threatening. In addition, there is a broad spectrum of the anatomic variability for the arterial supply of the liver.
Methods
Based on a real but very rare clinical case, including its diagnostic management and short-term course, the extraordinary coincidence of (i) an aneurysm of the gastroduodenal artery at its branching off from the hepatic artery and (ii) occurrence of hepatomesenteric trunk is described by the means of a scientific medical case report as well as an adequate and selective literature search.
Case presentation, therapeutic decision and clinical course
A 39-year-old woman (BMI, 24 kg/m2) was diagnosed (by coincidence) with an aneurysm of the proper hepatic artery (APHA) with overlap to the gastroduodenal artery in combination with an uncommon hepatomesenteric trunk using abdominal computed tomography (CT) scan (because of slight but recurrent episodes of urinary tract diseases) and, subsequently, systematic diagnostic comprising Duplex ultrasonography, magnetic resonance imaging (MRI), and conventional angiography. However, medical history was not significant for coincidence with possibly relevant chronic occlusive disease, mycotic embolization, trauma, Marfan syndrome, Klippel–Trenaunay syndrome or giant cell arteritis. Despite a moderate progression within a year to a size of actually 18 mm, we still favor watchful-waiting at this size (therapeutic [interventional] consequence, size > 20 mm) with short-term intervals for follow-up investigations using Duplex ultrasonography as the method of choice.
Conclusions
This is the first case in the accessible English-speaking literature to show this very infrequent coincidence especially indicating rare appearance of an APHA in combination with an also infrequent hepatomesenteric trunk (which potentiates the uncommon occurrence of such combination) based on the high anatomic variability of the arterial supply of the liver from the anatomic perspective.
Zusammenfassung
Grundlagen
Aneurysmata der Viszeralarterien sind selten, allerdings im Rupturfall lebensbedrohlich. Daneben gibt es eine breite anatomische Variabilität in der arteriellen Gefäßversorgung der Leber.
Methodik
Basierend auf einem realen, jedoch sehr seltenen klinischen Fall incl. seinem diagnostischen Management und mittelfristigen Verlauf, wird die außerordentliche Koinzidenz eines i) Aneurysmas der A. gastroduodenalis im Abgangsbereich aus der A. hepatica und ii) bestehenden Trunkus’ hepatomesentericus mittels wissenschaftlichem Fallbericht und einschlägiger (selektiver) Literaturrecherche beschrieben.
Fallpräsentation, Therapieentscheidung und klinischer Verlauf
Eine 39 Jahre alte Frau (BMI, 24 kg/m2) wurde zufällig mit einem Aneurysma der A. hepatica propria (APHA) mit Übergriff auf die A. gastroduodenalis in Kombination mit einem seltenen Truncus hepatomesentericus mittels Abdominal-CT (wegen rezidivierender Harnwegsinfektionen) und nachfolgend systematischer Diagnostik durch Duplexsonographie, MRT sowie DSA diagnostiziert. Die Anamnese war unauffällig hinsichtlich einer Koinzidenz mit pAVK, mycotischer Embolisation, Trauma, Marfan-Syndrom, Klippel-Trenaunay-Syndrom oder Riesenzellarteriitis. Trotz moderater Progression innerhalb eines Jahres auf eine Aneurysmagröße von gegenwärtig 18 mm wird nach wie vor die klinische Beobachtung mit Duplexsonographiekontrollen als Methode der Wahl in moderaten Zeitintervallen favorisiert (Op-Konsequenz: Durchmesser > 20 mm).
Schlussfolgerungen
Es handelt sich hier um den ersten Fall in der zugänglichen Englisch-sprachigen Literatur, der die sehr seltene Kuriosität vor dem Hintergrund des seltenen Auftretens der AHPA zusammen mit einem ebenfalls seltenen Truncus hepatomesentericus schildert, womit die seltene Fallkonstellation noch potenziert wird trotz aller individueller Variabilität der arteriellen Leberversorgung aus anatomischer Sicht.
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We have no financial or other relations that could lead to conflict of interest regarding publication.
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*Authors are equally involved in manuscript idea, first draft, establishing authorship, corrections, proof-reading, and submitting the manuscript; therefore both of them should be considered first authors.
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Bueschel*, P., Meyer*, F., Weber, M. et al. Rare aneurysm of the hepatic artery with overlap to the gastroduodenal artery in very uncommon coincidence with occurence of hepatomesenteric trunk. Wien Klin Wochenschr 125, 111–114 (2013). https://doi.org/10.1007/s00508-012-0317-8
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DOI: https://doi.org/10.1007/s00508-012-0317-8
Keywords
- Aneurysm
- Visceral artery aneurysm
- Aneurysm of the hepatic artery
- Hepatomesenteric trunk
- Arterial supply of the liver
- Anatomic variability