Elsevier

Cardiovascular Pathology

Volume 10, Issue 2, March–April 2001, Pages 99-101
Cardiovascular Pathology

Primary dissecting hepatic artery aneurysm in pregnancy

https://doi.org/10.1016/S1054-8807(01)00056-4Get rights and content

Abstract

A 32-year-old 32 weeks pregnant primigravida presented with acute abdomen and died 13 h later. She was normotensive during her antenatal period and on admission. At postmortem, a primary dissecting aneurysm of the main hepatic artery extending into its intrahepatic right branch was found. The cause of the dissection was presumably pregnancy-related.

Introduction

Primary dissecting hepatic artery aneurysms, unaccompanied by aortic or other dissections (i.e., secondary dissection), have previously been reported in 12 cases only [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], none of which were associated with pregnancy. A combined aneurysm involving the coeliac and extending into the hepatic artery was however, described by Muller and Kim [9] in a lady presented with back pain after spontaneous abortion. We report the first case of pregnancy-related dissecting aneurysm of the main hepatic artery in which the rupture of the vessels has resulted in the death of a primigravida and her fetus.

Section snippets

Case report

A 32-year-old 32 weeks pregnant Caucasian primigravida was admitted to King's College Hospital, London, England on 20 September 1978 at 1445 h with sudden onset of upper abdominal pain since 1300 h. She had normal obstetric course and regular uterine contractions for the last fortnight. Her BP during the antenatal period ranged between 110/70 and 120/80. In 1975, she was admitted for correction of varicose veins of the leg and her BP was 130/70. She also had a previous history of urinary tract

Pathological findings

Postmortem examination showed a jagged tear of about 1.3×0.8 cm found in the common hepatic artery, 2.5 cm from its origin from the coeliac axis (Fig. 1). The tear led into a 3×2.5-cm cavity of clotted blood. Hemorrhage surrounded the hepatic artery and has dissected the vessels distally into the right lobe of the liver. The liver (1711 g) parenchyma was normal. There was a large quantity of clotted blood retroperitoneally spreading in all directions and approximately 2.5 l of blood in the

Discussion

Pregnancy-related primary dissecting aneurysms are rare and their rupture is associated with increased risk of foeto-maternal mortality [13], [14]. The lesion has been reported in several arteries including the aorta [14], [15], coronary [16], coeliac [9], splenic [17], middle colic [17], iliac [14], and in the present paper, in the hepatic artery.

There are two groups of factors which may explain the pathogenesis of arterial aneurysms in pregnancy; one is nonspecifically related to pregnancy

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