A GIANT ANEURYSM OF PROPER HEPATIC ARTERY IN A CRYOGLOBULINEMIC PATIENT ON HEMODIALYSIS: A CASE REPORT.

Abstract

Introductrion. Hepatic artery aneurysms (HAAs) are unusual vascular lesions often associated with many different pathological conditions. Most of reported cases are described in association with connective tissue diseases, such as polyarteritis nodosa and systemic lupus erythematosus. Case report. We observed a 52-year-old man with hypertension and HCV-related cryoglobulinemia complicated by end stage renal disease on replacement therapy by hemodialysis. He was admitted to our hospital because of the worsening of blood pressure values (170/110 mmHg) associated to new onset abdominal pain. After an initial physical examination, that showed a periumbelical bruit associated to a pulsatile mass in right hypocondrium, an abdominal ultrasound was performed with evidence of aneurysms of both the right branch (diameter max 4,5 cm) and the left branch (diameter max 1.5 cm) of the hepatic artery. An abdominal CT study was also performed and it confirmed the diagnosis of right intrahepatic artery aneurysm with partially thrombosed area in its peripheral distal portion. Discussion. Many different factors can contribute to the aneurysm formation in this patient. Vasculitic involvement due to cryoglobulinemic disease, therapy with steroid drugs, inflammatory state associated to HCV-related hepatitis, chronic kidney disease and replacement therapy by hemodialysis may all be involved in the development of the aneurysmatic hepatic lesion.