A Rare Confluence: Hepatic Artery Aneurysm and Infective Endocarditis in a Patient with a Mitral Valve Prosthesis.

Introduction: Hepatic artery aneurysm (HAA) is a rare condition, comprising only 0.1% of all arterial aneurysms, yet it is the most common visceral pseudoaneurysm with a 20% prevalence among such cases. Mycotic HAA in the context of infective endocarditis is uncommon and results from microbial invasion and arterial wall damage. Case description: A 73-year-old woman with coronary artery disease, atrial fibrillation, repaired mitral valve prolapse and on warfarin presented with sudden left lower quadrant abdominal pain. She was hypotensive (BP 60/45 mmHg) and exhibited periumbilical tenderness. Laboratory findings included white blood cell count 18,000 cells/μl, haemoglobin 7.7 g/dl, platelets 1,023,000/μl, aspartate transferase 509 U/l, alanine transaminase 313 U/l and positive SARS-CoV-2. Non-contrast CT of the abdomen/pelvis revealed haemoperitoneum, rectus sheath haematoma and a hypodense hepatic lesion. Contrast-enhanced CT confirmed a left hepatic lobe pseudoaneurysm, supported by Doppler ultrasound. Coil embolisation of the pseudoaneurysm stabilised the patient's haemodynamics. Blood cultures grew Conclusion: Mycotic HAAs - though rare - can be life-threatening, especially in anticoagulated patients with prosthetic valves. They often present only upon rupture. Prompt diagnosis, vascular intervention and empirical antibiotic therapy are essential for successful outcomes. LEARNING POINTS: Hepatic artery aneurysm is a rare vascular entity that typically presents with non-specific symptoms, making early diagnosis challenging.One notable aetiology is septic embolisation resulting from infective endocarditis.