SHM Converge Scientific Abstract ePoster Gallery-Spontaneous Tumor Hemorrhage as Initial Presentation of Hepatocellular Carcinoma

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This case report describes a 75-year-old man with atrial fibrillation and previously eradicated hepatitis C who presented with syncope, abdominal pain, hypotension, and rapid ventricular response. Initial labs were largely normal, but CT angiography revealed a 4.5 cm pedunculated hepatic mass with capsular disruption and hemoperitoneum, indicating spontaneous tumor rupture and intra-abdominal bleeding. His hemoglobin fell from 14 g/dL to 10 g/dL.<br /><br />Tumor markers, including CEA, CA 19-9, and AFP, were normal. He had reactive HCV antibody but negative HCV RNA, and was negative for hepatitis B surface antigen though positive for core antibody. Because he was hemodynamically stabilized and the lesion was surgically accessible, he underwent laparoscopic liver segmentectomy and cholecystectomy. Pathology confirmed moderately differentiated hepatocellular carcinoma with negative margins.<br /><br />The discussion emphasizes that spontaneous rupture of hepatocellular carcinoma is rare but life-threatening, occurring in about 3% of cases, yet it accounts for a significant proportion of HCC-related deaths. Without treatment, 30-day mortality may reach 90%. Management options include transarterial embolization and surgical resection. In this patient, the absence of cirrhosis and the resectable nature of the mass allowed for potentially curative surgery.<br /><br />The report also highlights the poor prognosis of advanced HCC and the importance of surveillance, which can lead to early detection and markedly better outcomes. However, based on current guidelines, this patient would not have qualified for routine screening because he lacked cirrhosis and active hepatitis B infection.<br /><br />The key takeaway is that clinicians should maintain a high suspicion for intraperitoneal hemorrhage in patients with abdominal pain and hypotension, and consider spontaneous liver tumor rupture when a hepatic mass and ascites are present.

Asset Subtitle

Erin K. Hourigan

Meta Tag

Author List Allison Bush, Arnold Casey, Erik Shanahan MD, Erin K. Hourigan, Nicholas Nelson

Category Clinical Vignettes

Concept Spontaneous Rupture

Concept Hepatocellular Carcinoma

Concept Intraperitoneal Bleeding

Concept Transcatheter arterial embolization

Concept Surgical Resection

Distinguished Non-Finalist

Presenter Organization Naval Medical Center Portsmouth

Presenting Author Erin K. Hourigan

Track Adult

Keywords

hepatocellular carcinoma

spontaneous tumor rupture

hemoperitoneum

intraperitoneal hemorrhage

hepatic mass

atrial fibrillation

laparoscopic liver segmentectomy

tumor markers

hepatitis C

surgical resection

Spontaneous Rupture

Hepatocellular Carcinoma

Intraperitoneal Bleeding

Transcatheter arterial embolization

Surgical Resection