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Review
. 2020 Dec;48(12):300060520976474.
doi: 10.1177/0300060520976474.

Spontaneous internal hemorrhage of a giant hepatic hemangioma with infection: a case report and literature review

Ankang Wang  1   2 , Hao Chen  1 , Zhiwei Huang  1 , Hong Tang  3 , Hao Shi  1 , Jian Wen  1 , Qiu Li  1 , Yu Jiang  1 , Wenguang Fu  1
Affiliations
Review

Spontaneous internal hemorrhage of a giant hepatic hemangioma with infection: a case report and literature review

Ankang Wang et al. J Int Med Res. 2020 Dec.

Abstract

Spontaneous internal hemorrhage from a hepatic hemangioma is rare. This case describes a 59-year-old woman who was hospitalized with recurrent cough and fever for 6 months. The doctor thought that she had pneumonia, but other infectious diseases could not be ruled out. Therefore, related tests were performed and strong antibiotics were used, but the symptom of fever was persistent and recurred. Enhanced computed tomography (CT) findings showed a right hepatic giant hemangioma with hemorrhage, while tuberculosis, liver abscess, and immune disease were excluded by the physician. Because the patient's fever was associated with a large hepatic hemangioma, the patient was transferred to surgery. During treatment, the amount of bleeding increased, so she underwent a right hepatic hemangioma resection in the emergency department. Her postoperative fever symptoms subsequently resolved. Pathological examination confirmed hemorrhagic necrosis with infection in hepatic hemangioma. Follow-up showed that the patient was afebrile.

Keywords: Hepatic hemangioma; benign mesenchymal tumor; fever; hemorrhagic necrosis; infection; spontaneous internal hemorrhage.

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Conflict of interest statement

Declaration of conflicting interest: The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
a. On admission, chest CT scan revealed a mass flaky shadow of the right liver lobe. b. The first abdominal augmentation CT examination showed that the right liver lobe had a circular mixed density mass of about 10 × 9 cm, which had a clear boundary and contained a ring-shaped, strip-like slightly high-density shadow (shown by a white arrow). c. After 2 weeks, the high-density hemorrhage foci in the lesion increased compared with 2 weeks before. d. A postoperative CT scan showed a small amount of effusion. CT, computed tomography.
Figure 2.
Figure 2.
a. A well-encapsulated right hepatic hemangioma was observed during surgery. b. Cross-sectional examination of the mass revealed areas of necrosis within the hemangioma.
Figure 3.
Figure 3.
a. H&E staining, ×40 and b. H&E staining, ×100. Pathology demonstrated a cavernous hemangioma of the liver with hemorrhagic necrotic areas and inflammatory cell infiltration. c. H&E staining, ×40 and d. H&E staining, ×100. Numerous inflammatory cells infiltrated the cavernous hemangioma of the liver, and the hemangioma structure was destroyed. H&E, hematoxylin and eosin.
See this image and copyright information in PMC

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