CT features of hemorrhagic malignant liver tumors

Hemorrhage is a recognized occurrence in hepatocellular carcinoma but is infrequently seen with tumors metastatic to the liver. This complication was observed in three patients with primary hepatic malignancy and in four patients with hepatic metastases (melanoma, two; colon, one; breast, one) who were studied by CT. Hemorrhage occurred in the patient with metastatic colon carcinoma in the setting of anticoagulation. Definitive radiographic signs of hemorrhage were detected by CT in six of the patients, including hyperdense hepatic masses on noncontrast scans (four patients), high density peritoneal (one patient) and subcapsular fluid (one patient), and the hematocrit effect in peritoneal fluid (one patient). In three patients an irregular liver border adjacent to perihepatic fluid suggested the liver as the organ from which bleeding originated. There were four deaths, none of which was immediately related to the hemorrhagic complication.