Ultrasound guided biopsy of the liver is a commonly performed procedure, with clinically significant post-procedural haemorrhage thankfully uncommon.
The lessons from this case are:
1. Never be complacent (this is only the 3rd, but the worst haemorrhage of many hundred liver biopsies I have performed).
2. Follow pre-preparation protocols rigourously, although it doesnt mean haemorrhage 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 embolisation or surgery.
Ultimately the procedure helped the patient in that a treatable cause for his hepatic impairment was identified - herpes simplex hepatitis.