Spontaneous Hepatic Subcapsular Haematoma Due to Hepatic Artery Pseudo-Aneurysm Rupture: A Rare Case in an Elderly Male

Hepatic artery pseudo-aneurysm (HAPA) is a rare vascular complication that is typically associated with trauma or hepatobiliary procedures. Spontaneous rupture usually occurs without preceding trauma or intervention and is exceptionally uncommon. This case highlights a rare presentation of HAPA leading to a hepatic subcapsular haematoma in an elderly male. An 80-year-old male was admitted with confusion and had an unwitnessed fall at home. Initial investigations demonstrated severe hyponatraemia, elevated C-reactive protein, and left-basal consolidation on chest X-ray, along with a subsequent diagnosis of syndrome of inappropriate ADH secretion (SIADH) due to pneumonia. During admission, the patient then developed hypotension and a significant drop in haemoglobin. Subsequent contrast-enhanced CT scan revealed a hepatic subcapsular haematoma caused by a ruptured HAPA. The patient was urgently referred to interventional radiology, where selective catheterisation and coil embolisation were performed to secure complete haemostasis. Post-procedure, the patient's haemoglobin was stabilised, and liver function improved. This case illustrates that spontaneous rupture of a HAPA should be considered in elderly or septic patients with unexplained anaemia and abnormal liver function. Early imaging with contrast-enhanced CT scan and timely interventional radiology are essential for successful management.