A case of spontaneous hepatic hemangioma rupture: Successful management with transarterial chemoembolization alone

Abstract

Hemangioma is the most common benign hepatic tumor. Although spontaneous rupture is rare, the mortality rate ranges from 60 to 75%. Only 34 cases have been reported in the literature, with only one report using transcatheter arterial embolization (TAE) alone as treatment. We report a case of spontaneous rupture with "flowering sign" of a giant hepatic hemangioma, presenting with acute abdominal pain and shock, while the volume of the hemangioma and blood loss were similar. The patient was successfully managed by transarterial chemoembolization (TACE) alone, which has an operative mortality rate of up to 36.4%.

Keywords: CECT, contrast enhanced computerized tomography; Flowering sign; Hepatic hemangioma; Spontaneous rupture; TACE, transarterial chemoembolization; TAE, transcatheter arterial embolization; Transarterial chemoembolization.

Fig. 1

CECT of the abdomen showing a hemangioma in the right lobe of the liver. (A) The largest dimension of the lesion was 127 mm in the craniocaudal direction, and the antero-posterior measured 104 mm. (B) The blood lake of the hemangioma was clearly seen inside the lesion at the antero-posterior aspect, indicating the presence of active contrast extravasation. (C) The transverse section of the CECT of the abdomen measured 126 mm. (D) The hemangioma shrunk at the 6-month follow-up, with antero-posterior and transverse measurements of 87 and 93 mm, respectively. CECT: contrast-enhanced computed tomography.

Fig. 2

Digital subtraction angiography showing a hemangioma with active contrast extravasation, similar to blooming flowers, which we named “flowering sign”.