article · Radiology Case Reports
A 41-year-old woman using long-term oral contraceptives developed acute abdominal pain following vigorous physical exertion. Diagnostic imaging using CT and MRI revealed multiple bleeding liver lesions known as hepatocellular adenomas, measuring 12 centimetres and 3 centimetres across. The larger lesion was accompanied by a subcapsular hematoma, though scans showed no active contrast leak. Due to declining haemoglobin levels and worsening pain, the patient underwent selective arterial embolisation. This procedure successfully achieved clinical and biological stabilisation. Subsequent histopathological analysis identified the mass as an inflammatory hepatocellular adenoma. Follow-up imaging confirmed the resolution of the hematoma and the regression of the tumours. This experience demonstrates that internal bleeding can affect smaller adenomas as well as large ones, and treatment decisions should prioritise worsening patient symptoms over the absence of visible active contrast leakage on scans.
Benign liver tumours can rupture and cause life-threatening internal bleeding, sometimes provoked by strenuous physical activity. This report underlines the importance of combining clinical assessments with diagnostic scans. Medical teams must recognise that negative imaging for active bleeding should not delay minimally invasive catheter-based interventions when a patient exhibits clear clinical signs of continuous blood loss.
The abstract describes an individual clinical case treated with established endovascular methods and does not indicate an application pathway.
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We report a 41-year-old woman with long-term oral contraceptive use who developed acute right upper quadrant pain immediately after vigorous physical exertion. CT and MRI demonstrated multifocal hemorrhagic hepatocellular adenomas, including 12-cm and 3-cm lesions, both containing intralesional hemorrhage. The larger lesion was additionally associated with a subcapsular hematoma, without definite active contrast extravasation on CT. Persistent hemoglobin decline and worsening pain prompted selective arterial embolization, resulting in clinical and biological stabilization. Histopathological examination confirmed an inflammatory hepatocellular adenoma, and follow-up imaging demonstrated hematoma resolution and lesion regression. This case highlights that hemorrhagic changes may also occur in smaller adenomas and that the absence of visible active extravasation should not outweigh progressive clinical and laboratory evidence of ongoing bleeding when considering endovascular treatment.
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DOI: 10.1016/j.radcr.2026.07.066
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