CC: abdominal discomfort and distension
ID: 33 yo female with asthma presents to an OSH ED with abdominal discomfort, distension, fatigue, and difficulty sleeping. She underwent an abdominal ultrasound and was found to have a liver lesion, concerning for abscess, and was also incidentally discovered to be pregnant. She was transferred to USC for higher level care. Repeat abdominal US demonstrated a solid liver lesion suspicious for focal nodular hyperplasia or hepatic adenoma. She subsequently underwent an MRI that was read to be a nonspecific liver lesion. She then underwent a liver mass biopsy and results were suggestive of a hemangioma.
Pearls from morning report:
- Even if a patient does not have risk factors for HCC (ie. chronic hepatitis or cirrhosis), a specific type of liver malignancy, fibrolamellar carcinoma, can still arise in younger individuals.
- Hemangiomas are the most common benign hepatic tumor and most often asymptomatic with a low rate of complications, thus does not require surgical resection.
- Consider the use of antifungals for liver abscesses in neutropenic patients or patients on longer term TPN, and MRSA coverage for staph after recent instrumentation (such as TACE).
Hemangiomas may sequester platelets during surgery or other insults, triggering a bleeding diathesis and possibly internal bleeding. The triad of a giant hemangioma, thrombocytopenia, and consumptive coagulopathy is known as the Kasabach-Merritt Syndrome.
Marrero JA, Ahn J, Rajender Reddy, American College of Gastroenterology. ACG clinical guideline: the diagnosis and management of focal liver lesions. Am J Gastroenterol. 2014;109(9):1328-47.
Schwartz JM, Kuskal JB, Chopra S, Robson KM. Solid liver lesions: Differential diagnosis and evaluation. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. (Accessed on March 16, 2017)