Fatal Hemorrhagic Rupture of a Cystic Hepatic Hemangioma in a 27-Week Preterm Neonate

Hepatic hemangiomas are uncommon vascular tumors in the neonatal period and are rarely reported in extremely preterm infants. Cystic variants are exceptionally rare and may exhibit atypical imaging features, making early diagnosis challenging. Spontaneous rupture with massive hemorrhage represents a life-threatening complication. We report the case of a male neonate born at 27 weeks of gestation with a birth weight of 900 g who was initially admitted to the neonatal intensive care unit for respiratory distress syndrome. During hospitalization, the infant developed recurrent severe anemia associated with progressive hepatomegaly and abdominal distension requiring multiple packed red blood cell transfusions. Clinical examination revealed marked abdominal enlargement. Abdominal radiography and contrast-enhanced computed tomography demonstrated a large multiloculated cystic hepatic mass. The clinical course rapidly deteriorated with acute hemorrhagic anemia and progressive abdominal enlargement, ultimately resulting in death. Histopathological examination of a postmortem liver biopsy confirmed a ruptured cystic hepatic hemangioma. In very preterm neonates, unexplained anemia associated with hepatomegaly should prompt consideration of rare hepatic vascular tumors. Although exceedingly rare, ruptured cystic hepatic hemangioma carries a poor prognosis in this vulnerable population.