Congestive heart failure as a rare presentation of intratumoral bleeding of giant hepatic hemangioma: a case report and literature review
Zeki A. Abubeker, Zeru A. Sambi, Yonas T. HabtemariamIntroduction:
Cavernous hepatic hemangiomas are the most common solid benign liver tumors and are usually asymptomatic. Rarely, they can present with fatal complications such as rupture and bleeding. This case highlights that a common benign tumor can present with life-threatening complications and that prompt diagnosis and treatment can be lifesaving.
Case presentation:
A 45-year-old man presented with right-upper-quadrant abdominal pain, progressive dyspnea, and bilateral lower-limb swelling of 2 weeks’ duration. Clinical examination revealed signs of congestive heart failure and severe anemia. Contrast-enhanced computed tomography (CECT) demonstrated a giant hepatic hemangioma with intratumoral hemorrhage involving the right lobe of the liver. After stabilization with multiple blood transfusions, the patient underwent surgical resection. Histopathology confirmed a cavernous hepatic hemangioma with hemorrhagic changes. The postoperative course was uneventful.
Clinical discussion:
Intratumoral hemorrhage in hepatic hemangiomas is exceptionally rare but can have serious sequelae. In this case, the bleeding resulted in severe anemia, likely precipitating congestive heart failure – an outcome not previously reported. Imaging studies are essential for diagnosis, while invasive diagnostic procedures should be avoided whenever possible. Surgical resection is the definitive treatment for hemangiomas that are complicated by hemorrhage.
Conclusions:
Giant hepatic hemangiomas can rarely present with intratumoral bleeding, leading to severe anemia and congestive heart failure. Early diagnosis and appropriate surgical intervention are crucial in preventing a