50 years old HBV related CLD, HCC post liver transplant now presenting with melena
Findings
- A small 9 mm pseudoaneurysm is seen arising from extrahepatic segment of right hepatic artery proximal to the anastomotic site.
- Stenosis of right hepatic artery at anastomotic site noted with normal opacification of artery and its branches distally.
- Middle hepatic vein conduit to IVC with PTFE graft and biliary stent noted.
- Thrombosis of PTFE graft is seen.
- Ill-defined heterogeneously enhancing hypodense lesion is seen in periportal location extending along portal vein branches causing minimal dilatation of intrahepatic biliary ducts with multiple small ill-defined heterogeneously enhancing hypodense lesions in liver parenchyma.
Diagnosis
- Right hepatic artery psueudoaneurysm proximal to the anastamotic site and stenosis of right hepatic artery at anastamotic site.
- Extranodal periportal post transplant lymphoproliferative disorder (PTLD).
Summary
- Hepatic artery pseudoaneurysms are rare but life-threatening complications after liver transplant. Extrahepatic pseudoaneursyms are common and are most often mycotic. They may present with hemorrhage in gastrointestinal tract.
- PTLD is the second most common tumor in adult transplant recipients after nonmelanomatous skin cancer. Imaging patterns of PTLD can be nodal & extranodal.
Further reads
- Camacho, J. C., Moreno, C. C., Harri, P. A., Aguirre, D. A., Torres, W. E., & Mittal, P. K. (2014). Posttransplantation lymphoproliferative disease: proposed imaging classification. Radiographics : a review publication of the Radiological Society of North America, Inc, 34(7), 2025–2038. https://doi.org/10.1148/
- Brookmeyer, C. E., Bhatt, S., Fishman, E. K., & Sheth, S. (2022). Multimodality Imaging after Liver Transplant: Top 10 Important Complications. Radiographics : a review publication of the Radiological Society of North America, Inc, 42(3), 702–721. https://doi.org/10.1148/rg.210108
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