Subcapsular hepatic hematoma: a case of chronic expanding hematoma of the liver

Abstract

Background A chronic expanding hematoma (CEH) enlarges as a result of slight bleeding over several months, and the tissue shows a mixture of blood breakdown products, granulation tissue with capillary ingrowth, and inflammatory tissue. This report presents a case of a subcapsular hepatic CEH that was treated with transarterial embolization (TAE) and hepatectomy. Case presentation A 56-year-old man presented with vomiting and right-sided abdominal pain. Plain abdominal computed tomography (CT) showed a high-density area of fluid collection beneath the capsule of the right hepatic lobe, which was diagnosed as a hematoma. From its anatomical position on the CT images, a subcapsular hepatic hematoma was diagnosed. Though conservative therapy was provided, CT-guided percutaneous drainage and TAE were performed due to worsening symptom. Because the patient's abdominal symptoms re-appeared, extended right segmentectomy including the hematoma was performed. In the resected specimen, the hematoma was located beneath the capsule of the right hepatic lobe, and it was displacing the hepatic parenchyma. Microscopic examination showed a thick fibrous capsule around the hematoma, peripheral lymphocyte and plasmacyte invasion, and aggregations of histiocytes containing phagocytosed hemosiderin. Conclusions Anatomically, this was a case of a subcapsular hepatic hematoma, and pathologically it was shown to be a CEH. Complete surgical resection was effective treatment for this CEH.

Chronic expanding hematoma in the liver: a case report

“…Eleven cases occurred in the retroperitoneum and intraperitoneal organs (Table 1 ). Among them, CEH in the liver was reported in only one case [ 3 ], with our case being the second reported worldwide. In our case, no antiplatelet or anticoagulant medications were used and there was no history of trauma.…”

“…In addition, respiratory function examination showed a restraining pattern. Treatment of CEH involves complete removal of the tumor, including the cyst wall, to prevent recurrence, because it is highly possible that the fluid in the cyst will re-accumulate if only puncturing and drainage are performed [ 3 , 13 , 14 ]. In our case, the inside of the tumor was divided into several compartments by a blood clot, meaning that symptomatic improvement would have been unlikely by simple puncture and drainage.…”

“…In cases with strong adhesions to the surrounding tissues, massive bleeding may occur due to cyst wall damage. In cases with a large tumor diameter and a confirmed feeder artery in the cyst, preoperatively embolizing the feeder artery can reportedly block the inflow of blood and reduce tumor size, thus minimizing intraoperative bleeding [ 3 , 21 , 22 ]. By estimating the risk of bleeding using preoperative imaging examination of the tumor size, degree of inflammation, and blood flow findings on the cyst wall, we can consider additional preoperative treatment for cases with a high risk of bleeding.…”

Resection of chronic expanding hematoma within the liver cyst difficult to differentiate from liver cystadenocarcinoma: A case report

“…3 Although CEH is likely to occur in the limbs, there have been some reports of CEH in the liver that has been surgically resected. [6][7][8] In this retrospective review, we examined several studies to determine the optimal approach for this case. First, we considered differences in the frequency of occurrence.…”

The conservative management of a large hepatic subcapsular hematoma in a pregnant woman with preeclampsia: A case report

“…Computed tomography (CT) scan or magnetic resonance imaging (MRI) of the liver also has an extremely high sensitivity to diagnose liver rupture and assess the extent of the hepatic hematoma (6). Further, the embolization of intra-and extrahepatic arteries is recognized as an effective treatment for these hematomas, which are generally absorbed and disappear after the hemostasis of the hematoma (7). In this study, we reviewed a patient with a large liver hematoma with HELLP syndrome who had been conservatively managed.…”