Subcapsular Hematoma of Liver

Intermittent right upper quadrant abdominal pain prompted a 42-year-old woman to seek medical consultation. Ultrasonographic examination of the abdomen revealed cholelithiasis; percutaneous gallstone dissolution was performed.

Acute right upper quadrant abdominal pain developed after the procedure. A CT scan demonstrated a large hepatic subcapsular hematoma.

Dr Santosh Reddy of Middletown, Conn, comments that subcapsular hematoma of the liver is seen most commonly after blunt trauma or in association with hemolysis, elevated liver enzymes, and low platelet count (HELPP syndrome) of preeclampsia. A few cases have been reported of a hepatic subcapsular hematoma developing as a complication of lithotripsy, liver biopsy, or percutaneous dissolution of gallstones.^1-3 Initial management is conservative; treat the underlying cause of the hematoma and follow for changes in its size with serial CT or ultrasonography. Hepatic artery embolization or surgical intervention is indicated if symptoms persist or intensify or if the hematoma enlarges.

REFERENCES:1. McGrath FP, Lee SH, Gibney RG, Burhenne HJ. Hepatic subcapsular hematoma: an unusual complication of biliary lithotripsy. AJR Am J Roentgenol. 1990;154:1015-1016.
2. Mody MK, Kazerooni EA, Korobkin M. Percutaneous CT-guided biopsy of adrenal masses: immediate and delayed complications. J Comput Assist Tomogr. 1995;19:434-439.
3. Clouse ME, Falchuk KR. Percutaneous transhepatic removal of common duct stones: report of ten patients. Gastroenterology. 1983;85:815-819.