Abstract
Chronic expanding hematoma (CEH), first reported in 1968, is a hematoma that gradually enlarges over a long course of time after an initial period of bleeding. It can occur anywhere in the body; however, there are many reports of its occurrence in the thoracic cavity. Primary hepatic CEH is extremely rare. In this current study, we report on a case of primary hepatic CEH diagnosed preoperatively, with a review of the literature. A 68-year-old man presented with liver dysfunction. Abdominal computed tomography revealed a giant cystic tumor in the left lobe of the liver, with a longer axis of approximately 12 cm. Magnetic resonance imaging revealed a mosaic pattern with a mixture of high and low signals within the tumor on T1-weighted images and a high signal at the tumor margin on T2-weighted images. Based on these findings, primary hepatic CEH was suspected. However, other malignant tumors could not be excluded owing to tumor compression resulting in bile duct dilatation. Left trisectionectomy was performed, followed by bile duct drainage and percutaneous transhepatic portal vein embolization. Intraoperative hemorrhage was controlled by the Pringle maneuver and with temporary clamping of the inferior vena cava. Pathological examination revealed a pseudocyst containing a clot, consistent with CEH. In conclusions, the case report illustrates the potential to enhance preoperative diagnosis, inform surgical approaches, and minimize associated risks. Furthermore, it highlights the importance of increasing awareness and research on this condition for improved clinical decision-making and patient care.
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References
Tomita K, Chiba N, Ochiai S, et al. Prognostic value of future liver remnant LU15 index of 99mTc-galactosyl serum albumin scintigraphy for predicting posthepatectomy liver failure. PLoS ONE. 2021;16: e0247675.
Chiba N, Shimazu M, Takano K, et al. Predicting hepatic failure with a new diagnostic technique by preoperative liver scintigraphy and computed tomography: a pilot study in 123 patients undergoing liver resection. Patient Saf Surg. 2017;11:29.
Friedlander HL, Bump RG. Chronic expanding hematoma of the calf. J Bone Joint Surg Am. 1968;50A:1237–41.
Reid JD, Kommareddi S, Lankerani M, et al. Chronic expanding hematomas, a clinicopathologic entity. JAMA. 1980;244:2441–2.
Okada K, Sugiyama T, Kato H, et al. Chronic expanding hematoma mimicking soft tissue neoplasm. J Clin Oncol. 2001;19:2971–2.
Labadie EL, Glover D. Physiopathologenesais of subdural hematoma. Histological and biochemical comparison of subcutaneous hematoma in rats with subdural hematoma. J Nuerosurg. 1976;45:382–92.
Shinohara G, Andoh H. A case of chronic expanding hematoma required combined resection of bile duct. J Jpn Biliary Assoc. 2003;17:429–33.
Sunahara M, Kurauchi N, Tsunetoshi Y, et al. A case of intraabdominal chronic expanding hematoma treated by laparoscopy-assisted resection. J Jpn Surg Assoc. 2014;75:525–31.
Nakao K, Ban D, Otiai T, et al. A case of a primary hepatic chronic expanding hematoma. J Jpn Surg Assoc. 2015;76:90–5.
Tomimatsu H, Yoshida A, Kamimura N, et al. A case of chronic expanding hematoma arising in the hepatic cyst. Jpn J Clin Radiol. 2019;64:903–7.
Ihara A, Sanomura T, Hujimoto K, et al. A case of a primary hepatic chronic expanding hematoma. Jpn J Clin Radiol. 2020;65:433–8.
Yokokawa A, Yayama T, Kuroi C, et al. A case of chronic expanding hematoma that was difficult to differentiate from hepatic cystadenocarcinoma. Med J Jpn Red Cross Kochi Hosp. 2022;26:65–8.
Kobayashi T, Nakata T, Ide S, et al. A case of hepatic intracystic hemorrhage that was difficult to differentiate from mucocystadenocarcinoma. Med J MGH. 2021;33:32–5.
Ono Y, Kariya S, Nakatani M, et al. Subcapsular hepatic hematoma: a case of chronic expanding hematoma of the liver. BMC Gastroenterol. 2021;21:241.
Taniguchi A, Nishiyama T, Kozai J, et al. Chronic expanding hematoma in the liver: a case report. Surg Case Rep. 2022;8:209.
Shimagaki T, Sugimachi K, Mano Y, et al. Chronic expanding hematoma of the liver: a case report and review of the literature. Clin J Gastroenterol. 2023. https://doi.org/10.1007/s12328-023-01864-0.
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Study design: MN, NC and SK. Acquisition of data were performed by all authors. Operation procedures: MN and NC. Analysis and interpretation: MN, NC and MN. Manuscript drafted by MN and NC. Revision: NC and SK.
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Nakagawa, M., Chiba, N., Gunji, T. et al. Primary hepatic chronic expanding hematoma: a case report and literature review. Clin J Gastroenterol (2024). https://doi.org/10.1007/s12328-024-01927-w
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DOI: https://doi.org/10.1007/s12328-024-01927-w