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

Iwasaki, Yoshie; Tani, I; Nakajima, Yasuo; Ishikawa, Tohru; Umeda, Satoshi; Kusano, Shoichi

doi:10.1007/s003300000628

Cited by 11 publications

(6 citation statements)

References 12 publications

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“…The clinical picture was very similar to that of the present case. Hemorrhage due to injury to the caudate lobe often flows into the retroperitoneal cavity rather than into the abdominal cavity, resulting in a retroperitoneal hematoma [ 9 , 10 ]. Therefore, due to the limited space compared to the intraperitoneal, the patient may arrive at the hospital in a stable circulatory state immediately after the injury but may gradually enter shock and become severely ill.…”

Section: Discussionmentioning

confidence: 99%

Infant Caudate Lobe Injury With Retroperitoneal Hematoma: A Case Report

Imamoto¹,

Sawano²,

Ueta³

2022

Cureus

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Liver injury, especially caudate lobe injury, is an extremely rare form of injury in infants. In most cases, liver injury results in intraperitoneal hemorrhage when the capsule is ruptured, and circulatory dynamics deteriorate early. Caudate lobe injuries, however, often present with a high retroperitoneal hematoma. The diagnosis is difficult to identify with a focused assessment with sonography for trauma (FAST) in the initial treatment of trauma and may even be delayed without contrast-enhanced CT imaging. A one-month-old postoperative boy with congenital heart disease was involved in a motor vehicle accident and presented with a single caudate lobe injury. He was not wearing a seatbelt, and it was thought that the caudate lobe was injured due to shearing forces in the cephalocaudal direction at the time of the accident. The patient did not go into shock when he first came to our hospital, but a few hours after admission, he went into shock and required surgical hemostasis. The postoperative course was good, and the patient was discharged alive one month later. The lesson to be learned from this case is that caudate lobe injuries are often associated with retroperitoneal hematoma and slow deterioration of hemodynamics, so it is important not to miss small changes in the child's vitals and to be willing to perform contrast-enhanced CT imaging depending on the type of injury.

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Section: Discussionmentioning

confidence: 99%

Infant Caudate Lobe Injury With Retroperitoneal Hematoma: A Case Report

Imamoto¹,

Sawano²,

Ueta³

2022

Cureus

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“…When HCC ruptures in the caudate lobe, particularly in the Spiegel lobe, a hematoma is often formed inside the omental bursa (lesser sac) due to its anatomical position [1,3], and, though rare, a case in which a hematoma was formed in the retroperitoneum has also been reported [4]. …”

Section: Discussionmentioning

confidence: 99%

“…The liver is an organ inside the peritoneal cavity, so the rupture of HCC generally causes hemoperitoneum. Among these cases, few reports exist on the rupture of HCC originating from the caudate lobe [1,2] in which a hematoma is often formed in the omental bursa (also known as the lesser sac) [1,3]. On the other hand, hemothorax is a very unusual presentation of ruptured HCC, and is accompanied by high mortality secondary to uncontrollable hemorrhage because the negative pressure inside the pleural cavity makes spontaneous hemostasis difficult.…”

Section: Introductionmentioning

confidence: 99%

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

Ono¹,

Hiraga²,

Omura³

et al. 2012

World J Surg Onc

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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.

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“…Iwasaki et al and Lin et al reported cases similar to the present one, in which HCC of the caudate lobe of the liver burst and caused a lesser sac hematoma. 11,12 However, the mechanism of intracavitary hemorrhage caused by the ruptured HCC remains unclear. In the present case, bleeding was detected even in the subcapsule of the right hepatic lobe.…”

Section: Figurementioning

confidence: 99%

Cyst‐like extension of hepatic subcapsular bleeding caused by ruptured hepatocellular carcinoma into the bursa omentalis

Takahashi

Saito

Takahashi

et al. 2009

Hepatology Research

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An 81-year-old man, who experienced upper abdominal pain after shoveling snow, was admitted to a local hospital where a computed tomography (CT) showed a cystic lesion adjoining the pancreas. He was transferred to our department for detailed investigations and treatment. On ultrasonography, a tumor of the caudate lobe of the liver, with which the cystic lesion was continuous, was seen. The tumor of the caudate lobe of the liver was enhanced in the early phase of the CT but was washed out in the delayed phase. Subsequently, T1-weighted and T2-weighted Magnetic Resonance Imaging (MRI) images showed a low intensity and a high intensity, respectively. Since the cystic lesion was continuous with the tumor of the caudate lobe of the liver, its CT value was higher than that of water, and both the T1-weighted and T2-weighted MRI images showed a high intensity, which was attributed to a hematoma. Examination of the image suggested that rupture of a hepatocellular carcinoma (HCC) might have caused intracavitary hemorrhage. After the HCC was treated by transcatheter arterial embolization therapy, the patient was discharged. Subsequently, tumor enlargement was confirmed, and surgical removal of the tumor was 3 conducted at the hospital where the patient had originally presented. On histology, moderately differentiated HCC was diagnosed, but the cyst-like lesion was confirmed to be a hepatic subcapsular hematoma extending into the bursa omentalis. Although ruptured HCC often causes intraperitoneal bleeding, this rare case showed a cyst-like imaging finding in the form of a subcapsular hematoma within the bursa omentalis.

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

Cited by 11 publications

References 12 publications

Infant Caudate Lobe Injury With Retroperitoneal Hematoma: A Case Report

Infant Caudate Lobe Injury With Retroperitoneal Hematoma: A Case Report

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

Cyst‐like extension of hepatic subcapsular bleeding caused by ruptured hepatocellular carcinoma into the bursa omentalis

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