An Elderly Woman With a Presumed Giant Hepatic Chronic Expanding Hematoma Managed Conservatively With Imaging Surveillance

Background:Giant hepatic chronic expanding hematoma is a rare, benign liver condition in which blood forms a collection within the liver parenchyma or capsule that slowly increases in size for more than 1 month.Management may include biopsy to exclude malignancy and surgical resection, but imaging can identify the diagnostic features and monitor progression.This report describes the case of an older adult woman with a presumed giant hepatic chronic expanding hematoma managed conservatively with computed tomography (CT) imaging surveillance. Case Report:An 84-year-old woman admitted for acute heart failure had a giant hepatic mass detected incidentally on contrast-enhanced CT.The absence of arterial-phase hyperenhancement and normal serum tumor markers made hepatocellular carcinoma unlikely.Contrast-enhanced magnetic resonance imaging showed a right-lobe lesion measuring 13 × 14 × 17 cm with heterogeneous T1 and T2 signal intensities (mosaic sign) and no internal contrast enhancement, favoring chronic expanding hematoma, although primary hepatic sarcoma and sarcomatoid carcinoma could not be completely excluded.Considering her age, concurrent heart failure, and preference, she was managed conservatively with CT imaging surveillance.Non-contrast CT at 3, 6, 9, and 12 months showed an unchanged maximum axial diameter of 16 cm, and she remained free of abdominal symptoms or hepatic complications. Conclusions:Conservative management with CT imaging surveillance can be an individualized option for an older adult patient at high procedural risk with a presumed giant hepatic chronic expanding hematoma showing characteristic imaging features.Because the diagnosis was not confirmed histologically, predefined triggers for intervention and continued surveillance are required.