Ultrasound guided biopsy of the liver is a commonly performed procedure, with clinically significant post-procedural hemorrhage thankfully uncommon.

The lessons from this case are:

1. Never be complacent (this is only the 3rd, but the worst hemorrhage of many hundred liver biopsies I have performed).

2. Follow pre-preparation protocols rigourously, although it doesnt mean hemorrhage will never happen (this was a single pass, non-focal biopsy).

3. Post-procedural care from radiological procedures on return to the ward is vital.

The patient stablised, without the need for embolization or surgery.  

Ultimately the procedure helped the patient in that a treatable cause for his hepatic impairment was identified - herpes simplex hepatitis.