Spontaneous internal hemorrhage of a giant hepatic hemangioma

Abstract

Rationale:Hepatic hemangioma, a benign liver tumor, can rarely spontaneously rupture and hemorrhage, which is then associated with significant mortality. The diagnosis of internal hemorrhage is challenging and the management is disputed.Patient concerns:We describe the case of a 52-year-old female patient with chief complaints of fever and anemia, with no history of recent trauma.Diagnoses:Ultrasound suggested the possibility of a liver abscess and computed tomography (CT) examination revealed a giant space occupying lesion (SOL) (approximately 16 cm) in the right hepatic lobe, indicating a hepatic tumor or abscess. The patient did not respond to antibiotics and blood transfusion. Liver needle biopsy revealed blood clots suggestive of intratumoral hemorrhage, possibly of a hepatic hemangioma.Interventions:Interventional radiologic approach revealed active bleeding at the phrenic artery that supplied the liver SOL. Thus, embolization was performed and re-angiography showed no active bleeding from the embolized vessel. The patient became afebrile, but fever recurred the next day. Hence, an exploratory open right hemihepatectomy was undertaken and the intraoperative frozen biopsy confirmed hepatic hemangioma with internal hemorrhage, but malignancy could not be excluded for some focal tissues. Postoperative pathology report confirmed the diagnosis of hepatic hemangioma with internal hemorrhage and excluded malignancy.Outcomes:The fever subsided and the patient was discharged in good health. A follow-up CT performed three months, postoperatively, indicated compensatory growth of the left hepatic lobe.Lessons:This case demonstrates that the diagnosis of hepatic hemangioma with internal hemorrhage can be confirmed by needle biopsy and surgical resection is the optimal treatment for such a lesion.

Spontaneous internal hemorrhage of a giant hepatic hemangioma with infection: a case report and literature review

“…We reviewed seven published reports of fever that was caused by giant hepatic hemangioma. 10 , 23 – 27 Their characteristics and those of the current case report are summarized in Table 1 . Most patients were female and the mass was located in the right liver lobe.…”

“…3 – 5 Lesions larger than 4 cm have been defined as giant hemangiomas, which can trigger complications such as abdominal pain, bloating, nausea, vomiting, jaundice, and spontaneous or traumatic rupture. 6 – 9 There are few reports of spontaneous internal hemorrhage in hepatic hemangioma, 10 – 13 and it is even rarer to have fever of unknown origin. 10 In this context, we report a case of spontaneous internal hemorrhage with infection in a patient with a giant hepatic hemangioma, and we also reviewed the literature.…”

A Rare Presentation of Sudden Death due to Pulmonary Thromboembolism Possibly as a Result of Giant Hepatic Hemangioma

“…These complications may be mechanical in nature, such as spontaneous or traumatic rupture of the tumor, compression of adjacent structures such as the stomach, resulting in gastric obstruction, or the bile ducts, leading to obstructive jaundice. They may result in intratumoral or intraperitoneal hemorrhage , with or without consumptive coagulopathy (Kasabach–Merritt syndrome). They may have inflammatory effects, where patients present with acute or chronic fevers , and degenerative effects, such as thrombosis and hyalinization, possibly resulting in pulmonary embolism.…”

Spontaneous rupture of giant hepatic hemangioma: misdiagnosis as gastrointestinal perforation

“…To more comprehensively understand this disease, we searched the Web of Science, PubMed, and Medline databases for similar cases. After carefully reading the content of these reports, 10 articles on this disease were screened 9,10,13–20 (Table 1). These previous reports combined with our current case report will significantly contribute to the diagnosis and treatment of spontaneous rupture of giant hepatic hemangioma.…”