Percutaneous thrombin embolization of a hepatic artery mycotic aneurysm

A case is presented where abscess in association with a pseudoaneurysm was successfully treated by percutaneous thrombin injection rather than by conventional transcatheter methods. A 31-year-old male patient with a history of intravenous drug abuse was suffering from one week of upper abdominal pain, swinging pyrexia, and three times of vomiting. Examination of the abdomen revealed tender hepatomegaly. The patient was resuscitated and transfused with two units of red blood cells. A computed tomography (CT) scan of the abdomen was then performed, which demonstrated a hepatic abscess with a large pseudoaneurysm within the abscess cavity. A 22-gauge needle was inserted into the center of the pseudoaneurysm sac using an aseptic technique, under direct CT guidance. Six mm of d-stat flowable thrombin was then injected through the 22-gauge needle, and a scan immediately post-thrombin injection showed the typical changes of air and contrast within the aneurysm lumen.