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Young male patient with a gun-shot wound to the upper abdomen. Initially taken to surgery where a through and through injury to the liver was found. Surgical dissection into the hepatic hilum could not reach the source of hemorrhage. Patient was taken to the Interventional suite for angiogram and possible embolization. Image #1 is an angiogram of the common hepatic artery. There is extravasation of contrast from the bifurcattion of the right and left hepatic artery. Image #2 is with the catheter more distally in the proper hepatic artery which shows the injury more clearly. Notice the subtraction artifact from radiographic markers in lap sponges used to pack the injury during surgery.
Image #3
Image #3 is post-embolization. Approximately four coils were used for embolization. The coils were placed in the proper hepatic artery with complete embolization. In patients with normal hepatic function and normal flow in the portal vein, the risk of hepatic necrosis from embolization of the hepatic artery is 10%. |
