CT Diagnosis of Massive Hemorrhage from Hepatocellular Carcinoma

Computed tomographic findings of ruptured hepatic malignancy

“…[14]. Irregular liver contour consistent with cirrhosis, a large hepatic mass, an extrahepatic mass representing clot, and marked ascites may be seen in cases of massive hemorrhage from hepatocellular carcinoma [15]. In our cases, huge mass in the liver with lobulated contour, protruded mass, subcapsular hematoma, and/or hemorrhage in ascitic fluid were demonstrated.…”

Lesser sac hematoma as a sign of rupture of hepatocellular carcinoma in the caudate lobe

“…Computed tomography is highly accurate in the diagnosis of abdominal visceral hemorrhage [11]. The diagnosis of spontaneous rupture of HCC on CT is a peripheral hepatic tumor and a large amount of free intraperitoneal fluid with areas of high-attenuation rep-resenting acute blood clot around the liver [4]. The intraperitoneal high-attenuation clots are evident close to the tumor, suggesting that the tumor is the origin of the hemorrhage helping to exclude other possible sources [5].…”

“…The caudate lobe of the liver invaginates the superior recess of the lesser sac [3]. A fluid collection in the lesser sac is not a typical manifestation of benign ascites, and its presence should direct a search for a pathologic condition in neighboring organs and for peritoneal malignancy [4]. In rupture of hepatocellular carcinoma (HCC) CT demonstrates a peripheral hepatic tumor and a large amount of free intraperitoneal fluid with areas of high-attenuation representing acute blood clot, around the liver [4,5].…”

Imaging of Nontraumatic Hemorrhagic Hepatic Lesions

“…d. Figure 3. If laparotomy is undertaken, he-patic artery ligation, preferably of the branch supplying the liver lobe bearing the tumor, should be considered together with hemostasis of the rupture site by various means (suture plication, packing, argon beam coagulation, use of microwaves or absolute alcohol) (3)(4)(5)(6)(7)(8)(9)17,18). (a) Transverse US scan shows a well-circumscribed, complex mass with cystic and solid elements in the periphery of the right hepatic lobe (arrow).…”