Routine Percutaneous Biopsy of Right Lobe Liver Mass Under Ultrasound Guidance Results in Hemorrhagic Shock: A Case Report

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Hepatic Angiosarcoma is a rare, highly aggressive malignant vascular tumor of the liver that accounts for less than 1% of primary malignant liver tumors (1). Vascular complications related to routine percutaneous liver biopsies are uncommon but can result in catastrophic outcomes if not promptly recognized (2). We present a case of an ultrasound guided percutaneous liver biopsy that ultimately resulted in mortality despite timely interventional radiology management. This case highlights important diagnostic and therapeutic considerations for interventional radiologists.

The patient is 76-year-old male with a history of chronic liver disease and liver nodules who presented to the ED with one week of malaise, poor appetite, intermittent vomiting (occasionally blood-tinged), and worsening cough. History was limited due to hearing impairment. He was afebrile and hemodynamically stable. Physical exam showed chronic epigastric tenderness and jaundice. Labs revealed lymphopenia, elevated bilirubin (17.8), and elevated INR. CXR was nonspecific. He had no varices on prior EGD. He was admitted to medicine, and GI recommended admission. He was treated with Protonix and Zofran with symptom improvement; COVID-19 testing was planned. Post admission day one, a RUQ ultrasound showed innumerable liver lesions without biliary dilation or portal vein thrombosis which is consistent with prior CT and MRI imaging before initial presentation to the ED. The next day, a renal ultrasound showed two poorly defined areas of increased echogenicity of uncertain etiology.

This case highlights a patient with grossly abnormal cross-sectional imaging showing hypervascular liver lesions. Diagnostic radiologists should consider angiosarcoma when these patterns are observed due to the associated increased risk of hemorrhagic complications from percutaneous biopsy. Interventional radiologists should account for the risk when planning for a biopsy. Different strategies including using a smaller 20-gauge core needle instead of the standard 18-gauge core needle, or considering a transjugular approach may help mitigate bleeding.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 1961

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