An unusual case of hemoperitoneum: Ruptured hepatic artery aneurysm in a patient with fibromuscular dysplasia

Fibromuscular dysplasia is one of the most important mimics of vasculitis. It is a developmental disorder that affects primarily renal arteries. Hepatic artery involvement with FMD is infrequent. We present a rare case of a patient with FMD, who presented with intraabdominal bleeding due to hepatic artery involvement. CT evaluation was the clue to diagnose the cause of the acute abdominal pain, revealing peritoneal bleeding and a hepatic artery aneurysm that was subsequently confirmed by arteriography. Angiographic study showed changes in hepatic artery branches that pointed to FMD, and also allowed embolization of the bleeding aneurysm. The renal arteries were not affected. The characteristic angiographic appearance of the vascular changes in FMD with sole involvement of the hepatic arteries has been previously reported in only one case, to our knowledge [Jones HJ, Staud R, Williams Jr RC. Rupture of a hepatic artery aneurysm and renal infarction: 2 complications of fibromuscular dysplasia that mimic vasculitis. J Rheumatol 1998;25(October (10)):2015-8], but is one of the main arguments for the diagnosis, along with the lack of any supporting evidence for a generalized vasculitis process.