Spontaneous Hepatic Hemorrhage Associated with Myositis – A Case Report

Elizabeth Cabral Matos

Resumo


To report a clinical case of ruptured spontaneous hepatic haemorrhage associated with Dermatomyositis. A detailed analysis and description of the spectrum of US and MDCT findings, important diagnostic tools in this clinical setting – will be done, in line with a review of the state of the art literature.

A 52-years old woman with a past medical history of dermatomyositis presented with acute abdominal pain and vomiting. TDM signs of spontaneous liver haemorrhage with peritoneal haemorrhage –  are analysed and illustrated, highlighting MDCT and laboratory testing as a way to achieve a timely treatment.

Spontaneous hepatic bleeding with rupture is a very rare and poorly understood surgical emergency with a high mortality, with few cases reported in the literature. It is generally associated with an underlying condition (i.e. liver tumour, HELLP syndrome in pregnant woman, coagulation disturbances, connective tissue disorders or miscellaneous causes). There are few case reports in the literature regarding the association between myositis and spontaneous muscular haemorrhage.

Due to the unspecific manifestations, a high degree of clinical suspicion is needed to achieve prompt treatment. 


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Referências


 Srinivasa S, Lee WG, Aldameh A, Koea JB. Spontaneous hepatic haemorrhage: a review of pathogenesis, aetiology and treatment. International Hepato-Pancreato-Biliary Association Published Online First: 7 August 2015. DOI:10.1111/hpb.12474

 Mascarenhas R, Mathias J, Varadarajan R, Geoghegan J, Traynor O. Spontaneous haptic rupture: a report of five cases. International Hepato-Pancreato-Biliary Association. Published Online First by Elsevier Inc.: December 2002. DOI: http://dx.doi.org/10.1080/13651820260503819.

 Gelder HV, Gharibian N, Patel DB et al. Acute Haemorrhagic Myositis in Inflammatory Myopathy and Review of the Literature. Hindawi Publishing Corporation
Case Reports in Rheumatology.Published Online First: 14 October 2014. http://dx.doi.org/10.1155/2014/639756

 Furlan A, Fakhran S, Federle MP. Spontaneous Abdominal Hemorrhage: Causes CT Findings and Clinical Implications. AJR Am J Roentgenol. Published Online First: October 2009. DOI:10.2214/AJR.08.2231


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