Rupture of hepatocellular carcinoma after injury

[cellhc]

Presentation

Diagnosed hepatocellular carcinoma. Sudden onset of severe abdominal pain after a slight fall.

Patient Data
AGE: 35
GENDER: Male

CT

Axial non-contrast


Axial C+ arterial phase


Axial C+ portal venous phase


Axial C+ delayed

Irregular hepatic contour, heterogeneous hepatic parenchyma. There are multiple nodules and masses scattered throughout both lobes, poorly marginated, show mildly hypodense in the non-enhanced phase, heterogenous enhancement in the arterial phase, rapidly washed out in the portal venous and equilibrium phase, measuring ≤107x75 mm

Two mass lesions located in the periphery of segment 4, 8 had possibly ruptured

One large exophytic heterogeneously attenuating mass with a maximum-diameter of 72 mm, located on the left lower liver border, possibly arising from the ruptured mass in segment 4, pushing the bowels downwards, producing a typical sentinel clot sign

Partial thrombosis of the left portal vein

High-attenuation abdominal and pelvic intraperitoneal fluid possibly due to hemorrhage

Bibasilar multiple pulmonary nodules, moderately marginated, tissue density, measuring≤ 15 mm

Case Discussion
This patient has the typical multifocal hepatocellular carcinoma with rupture of segment 4 and 8 lesions; one large mass located on the left lower liver border possibly hematoma. High-attenuation abdominal and pelvic intraperitoneal fluid is possibly due to hemorrhage. Finally, bibasilar multiple pulmonary nodules are most likely metastases.

Rupture and hemorrhage especially after an injury is a complication of hepatocellular carcinoma with the patients that have large lesions located near the border of the liver.

"Sentinel clot sign" is a very important CT sign needed to be assessed to confirm the diagnosis.

References
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6476943/