Spontaneous Rupture of Multifocal Hepatic Artery Pseudoaneurysms in Systemic Lupus Erythematosus: A Rare Vasculopathic Emergency With Aberrant Hepatic Arterial Anatomy

Hepatic artery pseudoaneurysm is an uncommon but life-threatening vascular condition, and spontaneous rupture in a patient with systemic lupus erythematosus (SLE) is exceptionally rare. We report a 45-year-old woman with SLE who presented with acute abdominal distension, anaemia, and hemorrhagic shock. Computed tomographic mesenteric angiography demonstrated hemoperitoneum with multifocal hepatic artery pseudoaneurysms, including a ruptured pseudoaneurysm arising from a replaced right hepatic artery originating from the superior mesenteric artery, along with a second large left hepatic artery pseudoaneurysm. Emergency endovascular management was performed, achieving hemostasis while preserving hepatic perfusion. The patient recovered with supportive care and remained well at three-month follow-up. Early recognition of unexplained shock and abdominal symptoms in patients with connective tissue disease may facilitate timely imaging and life-saving intervention.