Venous hepatic aneurysms

A 76-year-old woman, with a previous medical history of mitral valve replacement, chronic heart failure (ejection fraction was 50% in October 2018) and atrial fibrillation, was first referred to our institution in March 2016 because of mild perturbation of liver injury tests. A first CT scan disclosed a 20 mm diameter slightly hypodense focal liver lesion in segment IVA (Fig. 1A). A doppler ultrasonography (US) of the liver disclosed that the lesion corresponds to a hypoechoic lesion with regular contours, with perception of vascular flow within it. In January 2017, a contrast-enhanced US (Fig. 1B) showed that the lesion in the left liver was a growing vascular lesion (35 mm diameter), with a relatively slow flow and late enhancement, suggesting a venous aneurysm. The largest segment IVA aneurysm fills early and communicates with a branch of the left hepatic vein in September 2020, which was confirmed by pulsed-waved Doppler (Fig. 1D). Regular follow-up disclosed progressive appearance of multiple identical lesions throughout the liver, gradually increasing in size until February 2023 (Fig. 1C and E) and each developed from the hepatic venous system. In addition, a partial thrombosis of one of the aneurysms in segment VII was diagnosed in April 2021 and of three of them in February 2023, probably related to the slow flow and low pressure within these aneurysms (Fig. 1F and G).