Hemothorax caused by spontaneous rupture of hepatocellular carcinoma: a case report and review of the literature

Abstract

We report a rare case in which hemothorax occurred in addition to hemoperitoneum due to spontaneous rupture of hepatocellular carcinoma (HCC) originating from the caudate lobe of the liver. The case pertains to a 56-year-old female who was transported to our hospital for impaired consciousness due to hemorrhagic shock. Computed tomography (CT) demonstrated ruptured HCC originating from the caudate lobe and accompanying hemoperitoneum and right hemothorax. Hemostasis was carried out by transcatheter arterial embolization (TAE), and surgery was conducted approximately one month after TAE. In the present case, no lesions as possible sources of bleeding were observed inside the pleural cavity, and, moreover, the diaphragm had no abnormalities in the intraoperative findings, suggesting that blood from the ruptured tumor may have traversed the intact diaphragm to enter the right pleural cavity soon after the HCC rupture. However, to the best of our knowledge, no similar cases of HCC have been reported to date, and this case is thus believed to be very rare. This unusual phenomenon may therefore be strongly associated with the location of the ruptured tumor and the formation of a hematoma inside the omental bursa. We discuss the mechanism causing hemothorax in the present case and also review the previously reported cases of ruptured HCC complicated by hemothorax.

Hepatocellular carcinoma with thoracic metastases presenting as hemothorax

“…In 2012, Ono et al [11] reviewed 17 cases of hemothorax caused by either metastasis or direct invasion in the chest. We further reviewed previous literature and found 21 cases (including the present case) of HCC with metastasis or direct invasion in the chest presenting hemothorax (Table 1); these cases are summarized in Table 2.…”

A Case of Hepatocellular Carcinoma Rupture Presenting as Hemothorax Following Radiofrequency Ablation

“…However, in the present case, despite the fact that the lesion representing the source of the bleeding was located in the abdominal cavity, massive bleeding was present in the thoracic cavity. There is only one report of such an HCC rupture in liver segment I being associated with a hemothorax [5]. In our case, the cause of this may have involved damage to the diaphragm, which serves as the boundary between the thoracic and abdominal cavities.…”

Hemothorax Caused by Spontaneous Rupture of Hepatocellular Carcinoma in the Pleural Cavity: A Case Report

“…Hemothorax associated with ruptured HCC has been reported in only 18 cases in the English and Japanese literature (3,4).…”