Spontaneous hepatic haemorrhage: what is the role of radiologist?

This poster is published under an open license. Please read the disclaimer for further details.

Congress:

ECR 2016

Poster Number:

C-0166

Type:

Educational Exhibit

Keywords:

Haemorrhage, Puncture, Chemoembolisation, Fluoroscopy, CT-Angiography, Catheter arteriography, Management, Liver, Interventional vascular

Authors:

F. Corvino¹, E. Cavaglia², A. Cervo³, M. Silvestre⁴, A. Corvino¹, F. Maglione¹; ¹Naples/IT, ²Napoli, NA/IT, ³Napoli /IT, ⁴Napoli/IT

DOI:

10.1594/ecr2016/C-0166

DOI-Link:

https://dx.doi.org/10.1594/ecr2016/C-0166

Fig. 1: Unenhanced CT (a) showing large hepatic mass on the right lobe with...

Fig. 2: Trans-arterial embolization DSA images of the same patient in Fig. 1 pre- (a)...

Fig. 3: (a) Selective angiogram of right hepatic artery show characteristic pooling and...

Fig. 4: (a-b) Axial CECT post-embolization of patient in Figure 3 show necrosis of the...

Learning objectives

The aim of this investigation was to review comprehensively the role of radiologist in diagnosis and management in patients with spontaneous hepatic haemorrhage.

Background

Spontaneous hepatic haemorrhage (SHH) is a rare condition resulting from a breach in the hepatic parenchyma that is mainly due to the rupture of an underlying hypervascular tumor. The most common causes of nontraumatic SHHare hepatocellularcarcinoma (HCC) and hepatocellular adenoma.Such hemorrhage can also occur in patients withother liver tumors, such as focal nodular hyperplasia(FNH), hemangioma, and metastases. Hepatocellular carcinoma (HCC) accounts for 15% of admissions with SHH in areas of high prevalence. In areas of low HCC prevalence, hepatic adenoma is often the leading cause...

Findings and procedure details

Because of its speed and widespread availability, CT plays an important role in the assessment of the presence, location, and extent of hemorrhage and in the identification of the underlying cause. The appearance of hemorrhage on CT depends on its age and location. On unenhanced images, acute bleeding has an attenuation of 30–45 HU because of its high protein content. In the first few hours after hemorrhage, clotted blood appears hyperdense (HU > 60) as the concentration of hemoglobin increases, with geographic areas of high...

Conclusion

Cross-sectional imaging with CT scanning is the mainstay of diagnosis and initial management emphasizes the use of arterial embolization to obtain haemostasis with a hepatectomy reserved for patients with bleeding tumours after formal staging and assessment of their liver function.

Personal information

F. Corvino,Department of Advanced Medical Biosciences, University Federico II of Naples (UNINA),Biostructures and Bioimmages Institution (IBB), National Research Council (CNR), viaPansini 5 I-80131 Naples, Italy. E. Cavaglia,Department of Vascular Radiology, A.O.R.N. Antonio Cardarelli, Via A. Cardarelli 9, 80100 Naples, Italy. A. Cervo,Department of Advanced Medical Biosciences, University Federico II of Naples (UNINA),Biostructures and Bioimmages Institution (IBB), National Research Council (CNR), viaPansini 5 I-80131 Naples, Italy. M. Silvestre,Department of Advanced Medical Biosciences, University Federico II of Naples (UNINA),Biostructures and Bioimmages Institution (IBB), National Research Council (CNR),...

References

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