PMC9631792_01
Transabdominal ultrasound observations at admission. (A) A heterogenic area was observed on the visceral surface of the left hepatic lobe, measuring 7.0 cm x 3.8 cm x 4.9 cm (arrow). (B) A hypoechoic area was observed in segment III of the liver, measuring 4.1 cm x 3.1 cm x 2.9 cm (B, arrow). (C,D) Fluid dark areas were detected in perihepatic (C, arrow) and right lower abdominal cavity (D, arrow).
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F1
Transabdominal US showed a 7.0 cm x 3.8 cm x 4.9 cm heterogenic lesion with well-defined margins on the visceral surface of the left hepatic lobe (Figure 1A), which was considered as hematoma. There was a hypoechoic mass in segment III measuring 4.1 cm x 3.1 cm x 2.9 cm (Figure 1B), considering the possibility of hepatic hemangioma. Meanwhile, fluid dark areas were detected in perihepatic and right lower abdominal cavity (Figures 1C,D), which was confirmed by ultrasound-guided abdominal paracentesis as old non-coagulant blood.
Liver magnetic resonance imaging (MRI) plain scan observations. The lesions in segment III and II of the liver were hypointense on T1-weighted images (A,B, arrow), but hyperintense on T2-weighted image (C,D, arrow). A large area of slightly longer T1 and shorter T2 signals is seen below the left hepatic lobe (A,C, asterisk).
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F2
Two lesions were found in the left lateral lobe of liver, which were hypointense in T1-weighted images (Figures 2A,B) and subtle hyperintensity in T2-weighted images (Figures 2C,D), indicating a high possibility of hemangioma. Moreover, there was a large hematoma on the visceral surface of the left hepatic lobe with longer T1 and shorter T2 signals (Figures 2A,C).
Intraoperative photographs, specimen photographs and Pathological examination. (A) A subcapsular hemotoma with a marked laceration was found on the visceral surface of the left hepatic lobe. (B) A hepatic hemangioma was observed on the surface of segment II. (C) Surgical specimen demonstrated a rounded, grayish-yellow, and non-encapsulated nodule with well-defined margins under hemotoma. (D) The lesion under hepatic hemotoma was SNNL, characterized as the central necrotic tissue surrounded by a fibrous capsule containing inflammatory cells (H&E, x 100). (E) The appearance of cross-sectional surface for lesion in segment II was grayish-brown. (F) The lesion in segment II was demonstrated to be hepatic hemangioma (H&E, x 100).
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F3
A large ruptured hematoma on the visceral surface of the left lateral lobe of liver was evident with small amount of active bleeding (Figure 3A). Meanwhile, a hemangioma on the diaphragmatic surface of the hepatic segment II was also found (Figure 3B). When the specimen was dissected, a rounded, 4 cm in diameter, grayish-yellow and non-encapsulated nodule with well-defined margins was observed under the hematoma (Figure 3C). This nodule was demonstrated to be SNNL by histological examination, characterized as the central necrotic tissue surrounded by a fibrous capsule containing inflammatory cells (Figure 3D).