Yoo Won Sang, Kim Nam Hee, Kang Min Ho, Yun Se Young, Kim Suk Bae, Shin Jung Eun, Park Yun Chan, Song Il Han
Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea.
Korean J Gastroenterol. 2008 Jun;51(6):385-90.
Spontaneous intrahepatic bleeding is a rare condition. In the absence of trauma, intrahepatic hematoma may be due to underlying liver disease. We report a case of hepatocellular carcinoma in the patient who had huge intrahepatic hematoma without definite intrahepatic tumor at the time of initial presentation. A 54-year-old man was admitted to our hospital with a sudden onset of upper abdominal pain. Initial abdominal CT scan showed huge hematoma measuring more than 13 cm in diameter in the right lobe of the liver. However, there was no enhancing lesion in the liver. Laboratory data showed high alanine aminotransferase, alpha-fetoprotein and positive HBsAg. The MRI and angiography could not also depict any mass in the liver. The patient was treated with percutaneous drainage on the intrahepatic hematoma. The cytology from drainaged blood revealed no malignant cell. After hematoma decreased, follow-up CT scan depicted an enhancing tumor in the liver. He underwent right hepatic lobectomy and histopathological examination showed hepatocellular carcinoma.
自发性肝内出血是一种罕见的病症。在无创伤的情况下，肝内血肿可能归因于潜在的肝脏疾病。我们报告一例肝细胞癌患者，该患者在初次就诊时存在巨大肝内血肿，但未发现明确的肝内肿瘤。一名54岁男性因突发上腹部疼痛入院。初次腹部CT扫描显示肝脏右叶有一个直径超过13厘米的巨大血肿。然而，肝脏内没有强化病变。实验室数据显示谷丙转氨酶、甲胎蛋白升高且乙肝表面抗原呈阳性。MRI和血管造影也未显示肝脏内有任何肿块。该患者接受了肝内血肿的经皮引流治疗。引流血液的细胞学检查未发现恶性细胞。血肿缩小后，随访CT扫描显示肝脏内有一个强化肿瘤。他接受了右肝叶切除术，组织病理学检查显示为肝细胞癌。
