Abdominal Imaging

, Volume 33, Issue 6, pp 633–642 | Cite as

The various manifestations of ruptured hepatocellular carcinoma: CT imaging findings

  • Hyun Cheol KimEmail author
  • Dal Mo Yang
  • Wook Jin
  • Seong Jin Park


Hepatocellular carcinoma (HCC) has a tendency to rupture spontaneously which leads to a life-threatening condition. Disruption of the tumor surface or a tear in a parasitic feeding artery can cause HCC rupture leading to hemoperitoneum. When evaluating patients with a ruptured HCC, CT can detect tumors, determine tumor extent, define the presence of tumor bleeding, and show serial hematoma density changes. Thus, familiarity with the various CT findings of ruptured HCCs is essential to ensure proper diagnosis and treatment. In this pictorial essay, the authors illustrate the usual and unusual manifestations of ruptured HCCs, as visualized by CT, and include some angiographic correlations. CT findings predictive of HCC rupture are also discussed.


Computed tomography Liver Hepatocellular carcinoma Rupture Hemoperitoneum 


  1. 1.
    Lai EC, Lau WY (2006) Spontaneous rupture of hepatocellular carcinoma: a systematic review Arch Surg 141:191–198PubMedCrossRefGoogle Scholar
  2. 2.
    Casillas VJ, Amendola MA, Gascue A, et al. (2000) Imaging of nontraumatic hemorrhagic hepatic lesions Radiographics 20:367–378PubMedGoogle Scholar
  3. 3.
    Yeh CN, Lee WC, Jeng LB, et al. (2002) Spontaneous tumour rupture and prognosis in patients with hepatocellular carcinoma Br J Surg 89:1125–1129PubMedCrossRefGoogle Scholar
  4. 4.
    Kim PN, Kim IY, Bae WK, et al. (1991) Computed tomographic findings of ruptured hepatic malignancy Gastrointest Radiol 16:334–336PubMedCrossRefGoogle Scholar
  5. 5.
    Ngan H, Tso WK, Lai CL, et al. (1998) The role of hepatic arterial embolization in the treatment of spontaneous rupture of hepatocellular carcinoma. Clin Radiol 53:338–341PubMedCrossRefGoogle Scholar
  6. 6.
    Kanematsu M, Imaeda T, Yamawaki Y, et al. (1992) Rupture of hepatocellular carcinoma: predictive value of CT findings AJR Am J Roentgenol 158:1247–1250PubMedGoogle Scholar
  7. 7.
    Chearanai O, Plengvanit U, Asavanich C, et al. (1983) Spontaneous rupture of primary hepatoma: report of 63 cases with particular reference to the pathogenesis and rationale treatment by hepatic artery ligation Cancer 51:1532–1536PubMedCrossRefGoogle Scholar
  8. 8.
    Ong GB, Chu EP, Yu FY, et al. (1965) Spontaneous rupture of hepatocellular carcinoma Br J Surg 52:123–129PubMedCrossRefGoogle Scholar
  9. 9.
    Nagasue N, Inokuchi K, Kobayashi M, et al. (1977) Hepatoportal arteriovenous fistula in primary carcinoma of the liver Surg Gynecol Obstet 145:504–508PubMedGoogle Scholar
  10. 10.
    Zhu LX, Geng XP, Fan ST (2001) Spontaneous rupture of hepatocellular carcinoma and vascular injury Arch Surg 136:682–687PubMedCrossRefGoogle Scholar
  11. 11.
    Lubner M, Menias C, Rucker C, et al. (2007) Blood in the belly: CT findings of hemoperitoneum Radiographics 27:109–125PubMedCrossRefGoogle Scholar
  12. 12.
    Orwig D, Federle MP (1989) Localized clotted blood as evidence of visceral trauma on CT: the sentinel clot sign AJR Am J Roentgenol 153:747–749PubMedGoogle Scholar
  13. 13.
    Shanmuganathan K, Mirvis SE, Reaney SM (1995) Pictorial review: CT appearances of contrast medium extravasations associated with injury sustained from blunt abdominal trauma Clin Radiol 50:182–187PubMedCrossRefGoogle Scholar
  14. 14.
    Chen CY, Lin XZ, Shin JS, et al. (1995) Spontaneous rupture of hepatocellular carcinoma. A review of 141 Taiwanese cases and comparison with nonrupture cases J Clin Gastroenterol 21:238–242PubMedCrossRefGoogle Scholar
  15. 15.
    Choi BG, Park SH, Byun JY, et al. (2001) The findings of ruptured hepatocellular carcinoma on helical CT Br J Radiol 74:142–146PubMedGoogle Scholar
  16. 16.
    Kim PT, Su JC, Buczkowski AK, et al. (2006) Computed tomography and angiographic interventional features of ruptured hepatocellular carcinoma: pictorial essay Can Assoc Radiol J 57:159–168PubMedGoogle Scholar
  17. 17.
    Kim TK, Han JK, Chung JW, et al. (1996) Intraperitoneal drop metastases from hepatocellular carcinoma: CT and angiographic findings J Comput Assist Tomogr 20:638–642PubMedCrossRefGoogle Scholar
  18. 18.
    Kim PN, Kim IY, Lee KS (1994) Intraperitoneal seeding from hepatoma Abdom Imaging 19:309–312PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Hyun Cheol Kim
    • 1
    Email author
  • Dal Mo Yang
    • 1
  • Wook Jin
    • 1
  • Seong Jin Park
    • 2
  1. 1.Department of Radiology, East-West Neo Medical CenterKyung-Hee UniversityGangdong-gu, SeoulRepublic of Korea
  2. 2.Department of Diagnostic RadiologySoonchunhyang University, Bucheon HospitalBucheonRepublic of Korea

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