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Actively bleeding ruptured hepatocellular carcinoma

Case contributed by Dachani Kansan Naider
Diagnosis almost certain

Presentation

Patient presented with severe abdominal pain and hypotension.

Patient Data

Age: 80 years
Gender: Female

Large volume contrast extravasation is evident surrounding hepatic capsule on arterial phase with further contrast accumulation on delayed imaging, reflecting high flow active bleeding.

The site of active hemorrhage arises from a 40mm hyperenhancing lesion located in inferior part of hepatic segment 5.

There is an associated large hemoperitoneum evident in the perihepatic, perisplenic, bilateral paracolic gutters and pelvic regions.

Hyperenhancing kidneys evident in the delayed phase. No other CT findings to suggest features of shock except for collapsed inferior vena cava.

Case Discussion

The patient presented with severe abdominal pain and was noted to be hypotensive. The patient has no prior history of liver cirrhosis.

CT demonstrated active bleeding from a hepatic lesion which correlates with the patient's presentation.

The patient was resuscitated in the emergency department and taken for an emergency laparotomy where the bleeding liver mass was resected. Histology confirmed hepatocellular carcinoma.

A hepatic adenoma is a differential diagnosis based on CT appearances and commonly occurs in younger females in the reproductive age group, a history of anabolic steroid use, pregnancy or hepatic steatosis. However, this is less likely in this case given the age of the patient and no history of steroid use.

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