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JAMA Surgery Clinical Challenge
January 2016

A Large Liver Mass With Acute Hemorrhage

Author Affiliations
  • 1Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
  • 2Department of Radiology, Baylor College of Medicine, Houston, Texas
  • 3Division of Surgical Oncology, Department of Surgery, Baylor College of Medicine, Houston, Texas
  • 4Houston VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas
JAMA Surg. 2016;151(1):83-84. doi:10.1001/jamasurg.2015.1945

A previously healthy, African American man in his mid-60s with a history of hepatitis C cirrhosis (compensated) presented to the emergency department after collapsing at work with sudden-onset back and abdominal pain. He was hypotensive (blood pressure, 87/55 mm Hg) on arrival to the emergency department. The patient’s condition was rapidly stabilized and computed tomography with contrast demonstrated a large (12.4 × 10.2-cm) right hepatic mass with heterogeneous enhancement on arterial phase and intrahepatic and intraperitoneal hemorrhage (Figure 1A). Emergency angiography was performed by interventional radiology, demonstrating active contrast extravasation originating from the right hepatic artery. Embolization was performed with Gelfoam and microparticles, resulting in hemodynamic stability and a quick recovery. Delayed liver resection was subsequently performed (Figure 1B).

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