Traumatic Cystic Artery Pseudoaneurysm After Transjugular Liver Biopsy: A Case Report

Cystic artery pseudoaneurysms are a rare but life-threatening entity that commonly occurs as a sequela to acute cholecystitis. We present a case of a 52-year-old male with a past medical history of decompensated alcoholic liver cirrhosis who underwent a transjugular liver biopsy (TJLB) after correction of his baseline coagulopathy. On post-operative day one, the patient had significant blood loss with an inappropriate response to blood transfusions and without an identifiable source of bleeding. Imaging was obtained, which revealed findings for concerning active hemorrhage into the gallbladder lumen. Angiography was performed, demonstrating a cystic artery pseudoaneurysm with resultant bleeding into the gallbladder, necessitating intervention. The patient underwent successful endovascular embolization of the superior and inferior divisions of the distal cystic artery using multiple metallic coils. The patient was discharged after six days post-operatively without further incident. Follow-up imaging demonstrated no residual filling of the cystic artery pseudoaneurysm. This case highlights an important, albeit rare, complication of TJLB that interventionalists should be aware of due to its rarity and the potential for significant morbidity.