Successful Transcatheter Arterial Embolization for Hemothorax from a Spontaneous Rupture of Hepatocellular Carcinoma Metastasis to the Chest Wall in an Elderly Patient

Abstract

An 87-year-old man with hepatocellular carcinoma (HCC) presented with right-sided chest pain. Computed tomography revealed right bloody pleural effusion and an extravasation from an arterially enhanced mass in the right seventh posterior intercostal space. These findings indicated hemothorax from a rupture of HCC metastasis to the chest wall. Angiography of the intercostal arteries confirmed a hypervascular tumor, and transcatheter arterial embolization resulted in hemostasis. He was discharged with palliative care and remains alive after 9 months. Although hemothorax represents an unusual, life-threatening complication of HCC, our case suggests that transcatheter treatment can achieve hemostasis and a favorable survival even in elderly patients.

Rupture of liver metastasis in high‐volume metastatic prostate cancer patient on androgen deprivation therapy combined with upfront docetaxel chemotherapy

“…It is pertinent to mention that among mHSPC cases, liver metastasis occurred only in 1-5% of the cases 2-5 reflecting the rarity of spontaneous rupture of liver in mHSPC as compared to HCC-related liver ruptures that occur in 4.8-26% of the cases. 7,15 The risk factors of hepatic metastasis rupture include necrotic tendency, a subcapsular location, and a rapid tumor growth. 16,17 Moreover, tumor necrosis resulting from chemotherapy has also been cited as a possible risk factor for metastatic rupture.…”

“…To our knowledge, the present study is the first report describing spontaneous rupture of liver metastasis caused by mHSPC. It is pertinent to mention that among mHSPC cases, liver metastasis occurred only in 1–5% of the cases 2–5 reflecting the rarity of spontaneous rupture of liver in mHSPC as compared to HCC‐related liver ruptures that occur in 4.8–26% of the cases 7,15 …”

“…Despite the patient's poor clinical status, we were able to temporarily stabilize his hemodynamic parameters after TAE. Previous studies have reported successful TAE for metastatic liver rupture associated with various forms of cancer 15–17 . Mochimaru et al reviewed successful TAE in two out of 11 cases in which rupture of liver metastasis was observed in patients with lung cancer during chemotherapy, and the patients survived for a long period 16 .…”

“…It is pertinent to mention that among mHSPC cases, liver metastasis occurred only in 1–5% of the cases 2 , 3 , 4 , 5 reflecting the rarity of spontaneous rupture of liver in mHSPC as compared to HCC‐related liver ruptures that occur in 4.8–26% of the cases. 7 , 15 …”

Ruptured Hepatocellular Carcinoma: What Do Interventional Radiologists Need to Know?

“…Suoh et al. ( 85 ) reported a case of hemothorax secondary to spontaneous rHCC metastasis to the chest wall in an 87-year-old man who was treated with TAE, and transcatheter treatment can achieve hemostasis and a favorable survival even in this setting. Nagao et al.…”