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Pseudoaneurysm Formation and Hemobilia as Late Complications after Transarterial Chemoembolization and Radiofrequency Ablation for Hepatocellular Carcinoma

An 82-year-old man underwent transarterial chemoembolization and radiofrequency ablation (RFA) for a 42-mm hepatocellular carcinoma in segment IV. Thirty-eight months later, he was admitted to our hospital for acute cholecystitis that had spread to the ablated area. After he started antibiotic treatment, the inflammatory reaction gradually improved, but he developed acute cholangitis, and massive hemobilia was observed during endoscopic retrograde biliary drainage. An angiogram showed both a pseudoaneurysm of the left hepatic artery (LHA) and extravasation of the microcatheter into a marginal lesion of the ablated area. The pseudoaneurysm was considered to have been formed by inflammation that perforated the ablated area and intrahepatic bile duct. After embolization of the LHA, no further bleeding was observed. A pseudoaneurysm may develop from an infection, even several years after liver RFA.