Submitted by Margherita Sandano, General Surgeon, Milan Italy
A 50-year-old male patient presented in the emergency department with a chief complaint of progressively worsening abdominal pain for 2 days and a preliminary diagnosis of suspected pancreatitis. There was no history of blunt or penetrating trauma to the chest or abdomen.
I performed a POCUS examination of the abdomen to look for evidence of pancreatitis. The pancreas was normal in size, shape and echotexture. A large irregular heterogenous but predominantly anechoic mass was seen in the right lobe of the liver. No other pathology was observed in the abdomen.
We immediately performed a contrast enhanced CT scan of the abdomen. The CT scan confirmed active bleeding into the hemangioma. The interventional radiologist embolized the bleeder vessel. The patient stabilized within 2 hours of admission and was discharged after 2 days observation.
Liver hemangiomas are benign tumors composed of blood vessels. They are usually small and asymptomatic. While bleeding within hemangioma is rare, it can occur and cause significant abdominal pain. Ultrasound is often the first imaging test used to detect liver hemangiomas.
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