Hemorrhagic hepatocellular carcinoma managed with urgent transarterial particle embolization: A case report

Abstract

Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver and a major cause of cancer-related mortality worldwide. Although many cases follow an indolent course, spontaneous hemorrhage from HCC is a rare but life-threatening complication that requires rapid diagnosis and intervention. A 77-year-old man with hypertension, type 2 diabetes mellitus, and chronic kidney disease presented with chest pain and a new-onset generalized seizure. During hospitalization, he developed severe acute blood loss anemia, with hemoglobin declining to approximately 5.7-5.8 g/dL. Cross-sectional imaging revealed a large hypervascular left hepatic lobe mass with intratumoral hemorrhage and hemoperitoneum, suspicious for hepatocellular carcinoma. Although he remained hemodynamically stable, the lesion was considered at high risk for recurrent or catastrophic bleeding. Because transfer to a tertiary hepatobiliary center was initially declined, he underwent inpatient ultrasound-guided biopsy followed by urgent transarterial particle embolization of the left hepatic artery. Embolization achieved complete angiographic stasis without complications. Follow-up MRI demonstrated expected post-embolization necrotic evolution of the treated lesion. This case highlights that preserved hemodynamics do not eliminate the need for urgent hemorrhage control when a large hypervascular hepatic tumor carries a substantial risk of rebleeding.