Spontaneous rupture of hepatocellular carcinoma
Known HCC. Sudden onset of severe abdominal pain and hypotension. No trauma.
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Large mass at right hepatic dome with IVC invasion (arrow) typical of HCC with rupture close to the gall bladder fossa and bleeding into the adjacent peritoneal cavity producing a typical sentinel clot sign.
Although rare, spontaneous rupture and hemorrhage is a recognized complication of HCC. "Sentinel clot sign" is a very important CT sign pointing to the site of bleeding ie clotting occurs at the site of tissue rupture (higher HU of 45 - 60 with heterogenous appearance) whereas blood that leaks away from the liver remains liquid in the peritoneal cavity (ie layered effect with HU of ~ 40).