[Acute intrahepatic bleeding in a male patient with focal nodular hyperplasia].
METHODS
A 45-year-old man had acute bouts of pain in the right lower thorax with radiation to the mid-thorax and upper abdomen. For 3 years he was known to have coronary heart disease, for 4 years arterial hypertension and for 8 months, as an accidentally discovered finding, a liver cyst 2.5 cm in diameter, as well as an inhomogeneous focal lesion, demonstrable only by sonography, lying dorsally and close to the diaphragm in the right lobe of the liver, 3.0 x 3.5 cm which was not detected by computed tomography or magnetic resonance imaging. Physical examination at admission detected epigastric pain on pressure but no other abnormalities.


METHODS
Sonography showed the inhomogeneous hepatic lesion now to be 6.0 x 7.5 cm. Computed tomography demonstrated a space-occupying mass, 7.5 cm in diameter, dorsal to the hepatic cyst, partly hypo-, partly hyper-dense with marginal spotty enhancement after contrast-medium injection.


METHODS
As acute bleeding into the focal hepatic lesion was suspected, a laparotomy was performed and liver segments VII and VIII resected. On inspection there was a sharply demarcated yellowish-white tumor with a central haemorrhagic softening. Histology revealed focal nodular hyperplasia (FNH) without signs of malignancy.


CONCLUSIONS
In the case of a known but not definitively diagnosed focal hepatic lesion, acute upper abdominal pain can be a sign of acute bleeding into the lesion.
Dröge
C
C
Medizinische Klinik, Schwerpunkt Gastroenterologie und Onkologie, Städtische Kliniken, Dortmund.
Löhlein
D
D
Hausamen
T U
TU
D000208:Acute Disease; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D004562:Electrocardiography; D006470:Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D006965:Hyperplasia / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology*; D008107:Liver Diseases / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed
Akute intrahepatische Blutung bei einem männlichen Patienten mit fokalnodulärer Hyperplasie.