Mycotic cystic artery pseudoaneurysm successfully treated with transcatheter arterial embolisation.

An 82-year-old man was admitted to hospital for management of an acute cerebral infarct. During his rehabilitation he was given antibiotics for pneumonia. After the antibiotic treatment commenced, he developed hypovolaemic shock and fresh rectal bleeding. His haemoglobin level dropped from 102 g/L to 75 g/L. Oesophagogastroduodenoscopy found mild gastric erosion. Computed tomography (CT) revealed a distended gallbladder containing hyperdense material, suggestive of either hyperdense sludge or blood (Fig 1a). He responded well to blood transfusion, but biochemical testing showed an elevated serum alkaline phosphatase level (1064 IU/L), so another CT study was arranged. The second CT study revealed air inside the gallbladder and a small area of contrast staining in the gallbladder wall (Fig 1b). His haemoglobin level remained low, so hepatic, coeliac and mesenteric digital subtracted angiography was performed. A hepatic angiogram performed with a 5-F catheter (Cobra 1, Cook, Bloomington, US) demonstrated a pseudoaneurysm arising from a branch of the cystic artery (Figs 2a and 2b), with contrast extravasating into the biliary ductal system (Fig 2c). Embolisation of the cystic artery branch after superselective cannulation with a 2.7-F microcatheter (Progreat, Terumo, Somerset, US) was accomplished with microcoils (two 2 mm/2 cm Mycotic cystic artery pseudoaneurysm successfully treated with transcatheter arterial embolisation P I C T O R I A L M E D I C I N E