Presentation
Abdominal pain.
Patient Data
Rounded, hypoenhancing left hepatic lobe (segments 2/3) mass with a small irregular arterial branch extending along the anterior margin into surrounding perihepatic blood. Surrounding heterogeneous perfusion related to compression of the liver parenchmya. Hepatic steatosis.
Small amount of pelvic haemoperitoneum.
Case Discussion
Acute rupture of hepatocelluar carcinoma (HCC), confirmed on resection where complete infarction of the specimen was found. It is important to recall that HCC or adenomas are the tumours most likely to rupture and that rupture results in urgent presentation with haemoperitoneum. In this case, the relatively older patient age, demographic, and risk factors (alcohol use) made HCC the most likely diagnosis. When there is rupture and haemorrhage, the tumour often infarcts, sometimes completely, and can shrink substantially on follow-up exams if not resected. Additionally, because there is active bleeding, one should not expect to see the typical "arterial hyperenhancement and portal venous washout" that defines HCC, but rather use the other clues to make the diagnosis.
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