S. De Cooman

Should Ruptured Liver Haemangioma Be Treated by Surgery or by Conservative Means ? A Case Report

Abstract Spontaneous rupture of a liver haemangioma is a rare but life-threatening acute clinical situation following haemorrhage within the liver, the subcapsular space and the peritoneal cavity in cases of capsular rupture. Rupture of a liver haemangioma has been reported to occur spontaneously in the majority of cases. In the past, prompt surgical treatment was recommended but was associated with high morbidity and mortality. Currently, conservative management and, in cases of recurrent haemorrhage, delayed surgery may be proposed. We report a case of spontaneous rupture of hepatic haemangioma treated by arterial embolisation and conservative means. The literature is also reviewed.

Venous thrombosis associated with catheter-related mediastinal perforation due to catheter mispositioning.

A 57-year old woman with an epidermoid carcinoma of the rhinopharynx was referred at our institution for treatment. A Totally Implantable Venous Access Device (BRAUN, Model CELSITE ST301) was placed percutaneously in the left subclavian vein under radioscopy. The postoperative chest x-ray showed no complications but the tip of the catheter was situated too high. Its functionality was satisfactory and we decided to keep it in place and to use it for chemotherapy administration. Twenty months after her last treatment, she was admitted for asthenia and pyrexia. She complained about pain in her left superior arm during TIVAD testing. A cavography was performed and showed an extravasation of the contrast solution in the anterior mediastinum (Fig. 1). A thoracic CT was then performed to confirm the diagnosis and to exclude mediastinitis. It showed a complete thrombosis of the left brachio-cephalic trunk but no sign of mediastinitis (Fig. 2). TIVAD was removed and the patient was treated with low molecular weight heparin. The patient was monitored in the intensive unit care for 24 hours. The clinical evolution was uneventful and the patient was discharged on the second day. She presents without any complications at 21 months follow-up.