Idiopathic Spontaneous Intrahepatic Hemorrhage Initially Diagnosed as a Liver Neoplasm

Follow-up CT revealed an 18-mm-diameter intrahepatic mass in the segment 8, and extravasation was no longer identified in the hematoma (Figure 1A, below). Because there was no sign of active bleeding and his condition was already stable, invasive treatment including interventional radiology or surgery was not indicated, and conservative treatment with fasting, intravenous transfusion, and antibiotic therapy was performed. The differential diagnoses of the mass included a tumor that could either be poorly differentiated hepatocellular carcinoma (HCC), hepatic adenoma, hepatic angioma, or hepatic angiolipoma, and in any case, the origin of hemorrhage was suspected to be the tumor. [...]surgery to resect the tumor and remove the hematoma was scheduled, and 3 days before the surgery, transcatheter arterial embolization (TAE) was performed for the hepatic artery in the segment 8 to prevent intraoperative bleeding from the tumor. Magnetic resonance imaging is also used for diagnosing hematoma, and it is well-known that hematoma shows sequential changes in MRI signal intensity reflecting the degeneration of hemoglobin.3,4 Additionally, the signal intensity in hematoma is frequently heterogenic because hematoma usually comprises fresh and old hemorrhages. 4 The sequential change and heterogeneity of hematoma in MRI signal intensity would make the differential diagnosis difficult. [...]careful evaluation is required when encountering spontaneous liver hemorrhage with an intrahepatic mass on MRI.