Liver Hematoma: Causes, Diagnosis, And Treatment

What is a liver hematoma?

A liver hematoma is a pool of blood contained within the liver's capsule. It is usually caused by trauma (e.g., accidents or injury) but can also happen as a result of certain surgical or diagnostic procedures or even spontaneously. It can even be a complication of pregnancy. Liver hematomas can pose serious risks if they break or burst. 

It is very rare to encounter a liver hematoma unrelated to accidents, injuries, or procedures. Outside of trauma, predisposing causes may be surgery, liver biopsy, coagulopathy, or pregnancy.

People also ask: what is the difference between a liver hematoma and a hemangioma? 

While a liver hematoma is a pool of blood within the liver capsule, a hemangioma is actually a benign (non-cancerous) tumor made up of a cluster of blood vessels in the liver.¹ They are usually distinguishable on imaging and will have different causes and effects. Your doctor can provide more information about the two conditions. 

Symptoms of liver hematoma

Signs and symptoms of a liver hematoma can differ based on the extent of the hematoma and the cause but mainly consist of abdominal pain and sequelae of the extent of bleeding. Symptoms are also described as "non-specific." This means they can indicate many different conditions and do not precisely point to a liver hematoma. 

In saying that, the most common symptom of a liver hematoma is abdominal pain. Other signs and symptoms include low blood pressure, fever, and referred pain to the shoulder. 

In the case of traumatic liver hematomas, there is a high risk of rupture. Therefore, diagnosis will often be rapid, usually involving a CT scan. Patients will often present symptoms such as right upper quadrant pain, right shoulder tip pain, or hypertension.

If you have any of these symptoms and they concern you or do not seem to be going away, it is best to consult your doctor. 

Causes of liver hematoma

As mentioned, liver hematoma is usually caused by trauma. This can mean liver perforation or blunt trauma (damage caused by a non-sharp surface or object). This trauma can sometimes result from surgery or procedures such as a liver biopsy. 

There are also other, rarer causes. For instance, liver tumors can cause a liver hematoma. Here is an overview of some of the rare causes of liver hematoma. 

Complication in pregnancy

Hepatic hematoma is a very rare complication of pregnancy. It usually results from a hepatic (liver) rupture. This is seen in particular in the context of HELLP syndrome, which itself is associated with pre-eclampsia.²

The etiology is thought to be placenta-driven with coagulation and inflammation-based pathophysiology affecting the liver.

Rare causes of subcapsular liver hematoma

Subcapsular liver hematoma is a type of hematoma where blood builds up between two specific layers of liver tissue.³ It is usually associated with pregnancy-related conditions like pre-eclampsia. Sometimes, it can occur in the non-pregnancy population if they have physical damage to the liver or clotting disorders. However, there are other rare causes. 

Less common risk factors for subcapsular liver hematoma include liver tumors and lesions, anticoagulants, and being on dialysis. There are some even more obscure causes of this condition, including the overuse of tight corsets. 

How serious is a hematoma on the liver?

Liver hematoma is a dangerous and potentially life-threatening condition. However, this all depends on the individual case. If the liver hematoma ruptures into an abdominal space called the peritoneal cavity, there could be high mortality rates.

How to treat a liver hematoma

Because liver hematoma is a very serious condition, it needs to be investigated and treated quickly. It is essential to get to the hospital as soon as possible. 

Doctors will perform several investigations to confirm a liver hematoma diagnosis and determine the risks that the hematoma poses. These investigations include blood tests and scans, like a liver ultrasound and a CT or MRI. They may even need to carry out exploratory surgery to figure out what is going on. 

Sometimes, patients will only need to be monitored or may be sent home. This is often the case if the hematoma is small and stable and there is no rupture. However, surgery is the mainstay of treatment for any instances of complicated liver hematoma, and the patient may need blood transfusions or supplementation of blood clotting factors. 

In the case of a pregnancy-related liver hematoma, the baby may need to be immediately delivered via cesarean section. 

The lowdown

A liver hematoma is a pool of blood within the layers of functional tissue of the liver. It is a potentially serious and life-threatening condition, especially if it ruptures (breaks or bursts). 

Symptoms of liver hematomas are non-specific, meaning they do not solely point to a diagnosis of liver hematoma. The most common symptom is abdominal pain, although people also experience shoulder pain and low blood pressure. 

Most liver hematomas are linked to trauma or damage from investigations and procedures. However, there are other, less common causes, including liver tumors, complications of pregnancy, and others. 

Liver hematoma is an extremely serious condition, especially if it ruptures. In this case, the mortality rate is high, and the condition will need treatment quickly. Making a diagnosis will require many investigations. Treatment commences if there are risk factors or signs of rupture and can include surgery and blood transfusions.

People also ask

How common is liver hematoma in pregnancy?

Hepatic hematoma is an extremely uncommon complication of pregnancy. In fact, only 200 cases have been reported globally in published literature. It is almost always associated with eclampsia/pre-eclampsia, which are more common conditions affecting just under 5% of all pregnancies or are a subset of HELLP, which is thought to develop in about 0.1% of pregnancies.⁴

How can I tell how serious my liver hematoma is?

Doctors have to perform several investigations to discover how serious a liver hematoma is. This depends greatly on the positioning of the hematoma and other factors like pregnancy and blood clotting conditions.

Generally, if a liver hematoma is stable, it is significantly less serious than if it were to rupture (break or burst).