title: Hemothorax caused by spontaneous rupture of hepatocellular carcinoma: a case report and review of the literature.
abstract: We report a rare case in which hemothorax occurred in addition to hemoperitoneum due to spontaneous rupture of hepatocellular carcinoma (HCC) originating from the caudate lobe of the liver. The case pertains to a 56-year-old female who was transported to our hospital for impaired consciousness due to hemorrhagic shock. Computed tomography (CT) demonstrated ruptured HCC originating from the caudate lobe and accompanying hemoperitoneum and right hemothorax. Hemostasis was carried out by transcatheter arterial embolization (TAE), and surgery was conducted approximately one month after TAE. In the present case, no lesions as possible sources of bleeding were observed inside the pleural cavity, and, moreover, the diaphragm had no abnormalities in the intraoperative findings, suggesting that blood from the ruptured tumor may have traversed the intact diaphragm to enter the right pleural cavity soon after the HCC rupture. However, to the best of our knowledge, no similar cases of HCC have been reported to date, and this case is thus believed to be very rare. This unusual phenomenon may therefore be strongly associated with the location of the ruptured tumor and the formation of a hematoma inside the omental bursa. We discuss the mechanism causing hemothorax in the present case and also review the previously reported cases of ruptured HCC complicated by hemothorax.
authors.affiliation: Department of Surgery, Senboku Kumiai General Hospital, 1-30 Omagari-Torimachi, Daisen, Akita 014-0027, Japan. fuono_gi@ybb.ne.jp
authors.forename: Fuminori
authors.initials: F
authors.lastname: Ono
authors.forename: Masaki
authors.initials: M
authors.lastname: Hiraga
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Omura
authors.forename: Manabu
authors.initials: M
authors.lastname: Sato
authors.forename: Akihiro
authors.initials: A
authors.lastname: Yamamura
authors.forename: Megumi
authors.initials: M
authors.lastname: Obara
authors.forename: Jun
authors.initials: J
authors.lastname: Sato
authors.forename: Shoichi
authors.initials: S
authors.lastname: Onochi
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000473:pathology / Q000601:surgery; D005260:Female; D006465:Hemoperitoneum / Q000473:pathology* / Q000601:surgery; D006491:Hemothorax / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D012196:Review Literature as Topic; D012422:Rupture, Spontaneous / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed