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Subcapsular Hepatic Hemorrhage: An Uncommon and Catastrophic Manifestation of Metastatic Melanoma

Year: 2025

Type: article

Abstract: Subcapsular hepatic hematoma is a rare but potentially life-threatening manifestation of metastatic melanoma, often presenting with vague abdominal pain and risk of misdiagnosis. We report a 76-year-old man with a history of malignant melanoma who presented with acute epigastric pain radiating to the right shoulder, vomiting, and a syncopal episode. While initial blood tests showed mild leukocytosis and raised lactate, a CT aorta excluded dissection but revealed multiple hepatic metastases with a large subcapsular hematoma and pulmonary nodules. A follow-up CT mesenteric angiogram demonstrated interval hematoma expansion without active bleeding, further metastatic progression, and a segmental pulmonary embolus. Owing to frailty and advanced malignancy, a multidisciplinary team recommended conservative management. This case highlights the diagnostic conundrum of hepatic hemorrhage in melanoma, which may mimic other acute pathologies such as aortic dissection or acute coronary syndrome. Prompt cross-sectional imaging, serial monitoring, and early multidisciplinary input are essential for accurate diagnosis and for balancing intervention risk against quality of life in complex oncology presentations.

Source: Cureus

DOI: 10.7759/cureus.94001

Authors: Akash Xavier, Sandra Toney, Hariharasudhan Balaji, Nithin Jyothy, Harsh Shah

Institutions: Southern Health and Social Care Trust, St.John's Medical College Hospital, Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells Hospital

Language: English

Topic: Case Reports on Hematomas

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

OpenAlex ID: W4414917490