Spontaneous intracapsular hemorrhage of a giant hepatic cavernous hemangioma: a rare case report and literature review

Abstract

Background Hepatic cavernous hemangioma is the most common type of benign liver tumor. Although ruptures and hemorrhages of hepatic hemangioma are rare complications, they are associated with high mortality. Most practitioners only pay more attention to abdominal hemorrhages caused by the rupture of hepatic hemangiomas. However, spontaneous intracapsular hemorrhages can often be neglected and poorly understood. Case presentation A 65-year-old man was referred to our institution with right upper quadrant pain, which had occurred suddenly and without a history of recent trauma. The blood test results were normal. Magnetic resonance imaging (MRI) of the abdomen showed a cystic mass in the right liver lobe. Considering the possibility of hepatic cystadenoma with hemorrhage, the patient underwent a right hepatic lobectomy. The pathological findings unexpectedly revealed intratumoral hemorrhage of hepatic hemangioma. The patient recovered well and was discharged eight days after surgery. Conclusions Intracapsular hemorrhage of hepatic cavernous hemangioma is challenging to diagnose and has a high potential risk of rupture. MRI is beneficial for diagnosing subacute internal hemorrhage cases, and it is recommended to undergo surgery for patients with a definitive diagnosis.

Transarterial embolization for rare spontaneous subacute intratumoral hemorrhage of hepatic hemangioma: a case report and literature review

“…The typical symptoms present with sudden severe abdominal pain, massive abdominal bleeding or hemorrhagic shock. Since the clinical course of hepatic hemangioma complicated with intratumoral hemorrhage is relatively mild and the symptoms are atypical, clinicians usually lack sufficient understanding of its severity ( 12 ). However, fever is a very rare symptom of intratumoral hemorrhage of hepatic hemangioma.…”

“…Compared to spontaneous rupture hemorrhage, intratumoral hemorrhage of hepatic hemangiomas is even rarer. Globally, only nine cases have been reported since 1993 ( 4 - 12 ) ( Table 1 ), of which only three cases received accurate preoperative diagnosis ( 5 , 7 , 11 ). Therefore, clinicians lack in-depth understanding of the diagnosis and treatment.…”

Interventional treatments for hepatic hemangioma: A state-of-the-art review

“…20 Compared with spontaneous or traumatic rupture of HH, the incidence of intratumoral hemorrhage is even lower, associated with atypical clinical symptoms, and only 9 cases have been reported worldwide. 21 Kasabach-Merritt syndrome, also known as hemangioma thrombocytopenia syndrome, is also an infrequent hemangioma-related complication, characterized by excessive blood cell depletion, leading to platelet drop, coagulation dysfunction, and hemorrhagic purpura that seriously threatens patients’ lives and requires immediate treatment. 22 , 23 The definition of giant hepatic hemangioma is still not unified; Chinese scholars mainly defined a giant hemangioma as a hemangioma with a diameter of ≥10 ​cm, 24 , 25 while non-Chinese scholars have typically classified a large hemangioma as one with a diameter of >4 ​cm.…”

Giant Hepatic Hemangioma Causing Prolonged Fever and Indicated for Resection

“…Fever improved over 28 days with observation. Most cases resolved after <1 month by resection (4,(16)(17)(18)(19)(20), whereas some experienced >3 months of fever (15,(21)(22)(23)(24) (Table 2). The possibility of hepatic hemangioma with necrosis or bleeding may have caused fever.…”