Rapidly Lethal Ruptured Hepatocellular Carcinoma With Disseminated Peritoneal Carcinomatosis on FDG PET/CT

Hepatocellular carcinoma (HCC) is the fourth most common cause of cancer-related death worldwide. Hepatocellular carcinoma commonly metastasizes to lungs, lymph nodes, and bone. Although HCC usually occurs in setting of chronic liver disease due to alcoholism or HBV/HCV infection, the incidence of HCC arising from nonalcoholic steatohepatitis is increasing. We present a very unusual initial presentation of occult HCC with peritoneal carcinomatosis secondary to liver rupture in a 70-year-old man with known nonalcoholic steatohepatitis-cirrhosis, best appreciated on FDG PET/CT. Our patient died a few days later. Tumor rupture is a rare but usually rapidly lethal complication of HCC.