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

BACKGROUND: Intratumoral hemorrhage of hepatic hemangioma is very rare. CASE DESCRIPTION: The case of a 54-year-old female with fever and anemia. Initial ultrasound was suggestive of liver abscess, but antibiotic treatment and blood transfusion did not alleviate the patient’s symptoms. After abscess puncture and drainage, the patient was admitted to our hospital due to bleeding effusion. The diagnosis of hepatic hemangioma with subacute intratumoral hemorrhage was considered by enhanced magnetic resonance imaging (MRI). The patient’s condition was managed with routine liver protection, anti-infection, fluid infusion and two transarterial embolization (TAE) sessions using pingyangmycin-lipiodol emulsion. After the treatment, the patient’s symptoms were resolved, the body temperature was normal and the anemia was corrected. Subsequently, we continued periodic follow-up of the patient for four years. The patient was generally in good condition, and there were no symptoms related to hepatic hemangioma, such as fever and anemia. The volume of hepatic hemangioma was reduced by half, and the intratumoral hematoma was obviously absorbed. CONCLUSIONS: For patients with previous history of hemangioma, timely MRI can provide higher diagnostic accuracy after they develop symptoms such as fever and anemia. TAE is also a safe and reliable alternative to surgical resection.