Multifocal hemorrhagic hepatocellular adenomas following vigorous physical exertion: Radiologic–pathologic correlation and endovascular management

We report a 41-year-old woman with long-term oral contraceptive use who developed acute right upper quadrant pain immediately after vigorous physical exertion. CT and MRI demonstrated multifocal hemorrhagic hepatocellular adenomas, including 12-cm and 3-cm lesions, both containing intralesional hemorrhage. The larger lesion was additionally associated with a subcapsular hematoma, without definite active contrast extravasation on CT. Persistent hemoglobin decline and worsening pain prompted selective arterial embolization, resulting in clinical and biological stabilization. Histopathological examination confirmed an inflammatory hepatocellular adenoma, and follow-up imaging demonstrated hematoma resolution and lesion regression. This case highlights that hemorrhagic changes may also occur in smaller adenomas and that the absence of visible active extravasation should not outweigh progressive clinical and laboratory evidence of ongoing bleeding when considering endovascular treatment.