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Spontaneous internal hemorrhage of a giant hepatic hemangioma: A case report

RATIONALE: Hepatic hemangioma, a benign liver tumor, can rarely spontaneously rupture and hemorrhage, which is then associated with significant mortality. The diagnosis of internal hemorrhage is challenging and the management is disputed. PATIENT CONCERNS: We describe the case of a 52-year-old femal...

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Autores principales: Hao, Fulong, Yang, Xiaoli, Tian, Yinsheng, Wang, Wenping, Ge, Minggang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5708954/
https://www.ncbi.nlm.nih.gov/pubmed/29381955
http://dx.doi.org/10.1097/MD.0000000000008702
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author Hao, Fulong
Yang, Xiaoli
Tian, Yinsheng
Wang, Wenping
Ge, Minggang
author_facet Hao, Fulong
Yang, Xiaoli
Tian, Yinsheng
Wang, Wenping
Ge, Minggang
author_sort Hao, Fulong
collection PubMed
description RATIONALE: Hepatic hemangioma, a benign liver tumor, can rarely spontaneously rupture and hemorrhage, which is then associated with significant mortality. The diagnosis of internal hemorrhage is challenging and the management is disputed. PATIENT CONCERNS: We describe the case of a 52-year-old female patient with chief complaints of fever and anemia, with no history of recent trauma. DIAGNOSES: Ultrasound suggested the possibility of a liver abscess and computed tomography (CT) examination revealed a giant space occupying lesion (SOL) (approximately 16 cm) in the right hepatic lobe, indicating a hepatic tumor or abscess. The patient did not respond to antibiotics and blood transfusion. Liver needle biopsy revealed blood clots suggestive of intratumoral hemorrhage, possibly of a hepatic hemangioma. INTERVENTIONS: Interventional radiologic approach revealed active bleeding at the phrenic artery that supplied the liver SOL. Thus, embolization was performed and re-angiography showed no active bleeding from the embolized vessel. The patient became afebrile, but fever recurred the next day. Hence, an exploratory open right hemihepatectomy was undertaken and the intraoperative frozen biopsy confirmed hepatic hemangioma with internal hemorrhage, but malignancy could not be excluded for some focal tissues. Postoperative pathology report confirmed the diagnosis of hepatic hemangioma with internal hemorrhage and excluded malignancy. OUTCOMES: The fever subsided and the patient was discharged in good health. A follow-up CT performed three months, postoperatively, indicated compensatory growth of the left hepatic lobe. LESSONS: This case demonstrates that the diagnosis of hepatic hemangioma with internal hemorrhage can be confirmed by needle biopsy and surgical resection is the optimal treatment for such a lesion.
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spelling pubmed-57089542017-12-07 Spontaneous internal hemorrhage of a giant hepatic hemangioma: A case report Hao, Fulong Yang, Xiaoli Tian, Yinsheng Wang, Wenping Ge, Minggang Medicine (Baltimore) 5700 RATIONALE: Hepatic hemangioma, a benign liver tumor, can rarely spontaneously rupture and hemorrhage, which is then associated with significant mortality. The diagnosis of internal hemorrhage is challenging and the management is disputed. PATIENT CONCERNS: We describe the case of a 52-year-old female patient with chief complaints of fever and anemia, with no history of recent trauma. DIAGNOSES: Ultrasound suggested the possibility of a liver abscess and computed tomography (CT) examination revealed a giant space occupying lesion (SOL) (approximately 16 cm) in the right hepatic lobe, indicating a hepatic tumor or abscess. The patient did not respond to antibiotics and blood transfusion. Liver needle biopsy revealed blood clots suggestive of intratumoral hemorrhage, possibly of a hepatic hemangioma. INTERVENTIONS: Interventional radiologic approach revealed active bleeding at the phrenic artery that supplied the liver SOL. Thus, embolization was performed and re-angiography showed no active bleeding from the embolized vessel. The patient became afebrile, but fever recurred the next day. Hence, an exploratory open right hemihepatectomy was undertaken and the intraoperative frozen biopsy confirmed hepatic hemangioma with internal hemorrhage, but malignancy could not be excluded for some focal tissues. Postoperative pathology report confirmed the diagnosis of hepatic hemangioma with internal hemorrhage and excluded malignancy. OUTCOMES: The fever subsided and the patient was discharged in good health. A follow-up CT performed three months, postoperatively, indicated compensatory growth of the left hepatic lobe. LESSONS: This case demonstrates that the diagnosis of hepatic hemangioma with internal hemorrhage can be confirmed by needle biopsy and surgical resection is the optimal treatment for such a lesion. Wolters Kluwer Health 2017-11-27 /pmc/articles/PMC5708954/ /pubmed/29381955 http://dx.doi.org/10.1097/MD.0000000000008702 Text en Copyright © 2017 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by-nc-nd/4.0 This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0
spellingShingle 5700
Hao, Fulong
Yang, Xiaoli
Tian, Yinsheng
Wang, Wenping
Ge, Minggang
Spontaneous internal hemorrhage of a giant hepatic hemangioma: A case report
title Spontaneous internal hemorrhage of a giant hepatic hemangioma: A case report
title_full Spontaneous internal hemorrhage of a giant hepatic hemangioma: A case report
title_fullStr Spontaneous internal hemorrhage of a giant hepatic hemangioma: A case report
title_full_unstemmed Spontaneous internal hemorrhage of a giant hepatic hemangioma: A case report
title_short Spontaneous internal hemorrhage of a giant hepatic hemangioma: A case report
title_sort spontaneous internal hemorrhage of a giant hepatic hemangioma: a case report
topic 5700
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5708954/
https://www.ncbi.nlm.nih.gov/pubmed/29381955
http://dx.doi.org/10.1097/MD.0000000000008702
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AT wangwenping spontaneousinternalhemorrhageofagianthepatichemangiomaacasereport
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