COVID-19-associated hepatic artery pseudoaneurysms.

Cases of coronary and pulmonary artery pseudoaneurysms secondary to COVID-19 have been reported in the literature and are supposed to be secondary to inflammatory and vasculitis processes linked to a viral multisystem inflammatory syndrome. Although the incidence of COVID-19-associated liver injury ranges from 14% to 53% in hospitalized patients, COVID-19-associated hepatic artery pseudoaneurysms have never been reported so far. We present the case of a patient whose follow-up CT after cryoablation of renal cell carcinoma revealed seven fusiform pseudoaneurysms of the two hepatic arteries secondary to COVID-19. Anticoagulant or anti-inflammatory treatments were not introduced. Vascular lesions were unchanged on the 3-month follow-up CT. At 6-month CT, the proximal pseudoaneurysm was replaced by a proximal occlusion of the accessory RHA.

body mass index

computed tomography

accessory right hepatic artery

A 59‐year‐old‐man was undergoing a biannual follow‐up after cryoablation of cT1aN0M0 right renal cell carcinoma performed in June 2020. He had various comorbidities, including active smoking (90 package‐year), essential arterial hypertension, type 2 diabetes and chronic obstructive pulmonary disease GOLD 2. However, his BMI was 23 kg/m2.

The post‐ablative CTs were featureless except for the presence of an accessory right hepatic artery (RHA) (Figure 1A). In June 2021, the patient contracted a COVID‐19 with fever and cough. A nasopharyngeal swab was performed and SARS‐COV‐2 virus was detectable by PCR, consistent with the diagnosis of COVID‐19. The patient had solely mild dyspnea and did not require oxygen therapy. He was not admitted and, therefore, he did not undergo chest CT scan or laboratory tests. He recovered spontaneously.

FIGURE 1

(A) Multiplanar reformation with maximum intensity projection (30 mm thickness) of the hepatic arteries on arterial‐phase contrast‐enhanced computed tomography performed prior to kidney cryoablation, showing the common hepatic artery (arrowhead) and an accessory right hepatic artery (arrow). (B) Contrast enhanced‐CT (arterial phase) showing fusiform pseudoaneurysms of both arteries. (C) Contras‐enhanced CT at 6 months showing the proximal occlusion of the accessory RHA (arrow, portal venous phase). (D) Contras‐enhanced CT at 6 months showing the persistence of pseudoaneurysms (arrowhead) on the common hepatic artery (arrow, arterial phase).

One month later (July 2021), follow‐up CT revealed seven fusiform pseudoaneurysms (Figure 1B) of the two hepatic arteries ranging between 16 and 19 mm in length and between 6 and 9 mm in width. The patient did not report any abdominal symptoms, asthenia or jaundice. Liver tests (alanine transaminase, aspartate transaminase; alkaline phosphatase, bilirubin, gamma‐glutamyltransferase and alkalin phosphatase) were normal. There was no liver insufficiency, albumin and prothrombin time were normal. Imaging follow‐up was advised by a multidisciplinary consultation meeting. The pre‐cryoablation coagulation profile was strictly normal thus no underlying vascular pathology was looked for. Anticoagulant or anti‐inflammatory treatments were not introduced. Vascular lesions were unchanged on the 3‐month follow‐up CT. At 6‐month CT, the proximal pseudoaneurysm was replaced by a proximal occlusion of the accessory RHA (Figure 1C). The two other pseudoaneurysms were unchanged (Figure 1D), and the patient remained asymptomatic. A bimonthly follow‐up was proposed for the patient.

Cases of coronary and pulmonary artery pseudoaneurysms secondary to COVID‐19 have been reported in the literature, and are supposed to be secondary to inflammatory and vasculitis processes linked to a viral multisystem inflammatory syndrome. Although the incidence of COVID‐19‐associated liver injury ranges from 14% to 53% in hospitalized patients, COVID‐19‐associated hepatic artery pseudoaneurysms have never been reported so far.

CONFLICT OF INTEREST

Michel Dupuis: none; Maxime Ronot: none; Tarik Asselah: none; Sylvain Bodard: none.