目的：根据肝细胞癌瘤内出血的CT表现，复习肝脏肿块自发出血的鉴别诊断。方法分析1例低分化肝细胞癌合并瘤内出血病人的CT表现并检索和复习肝脏肿块内自发出血的影像诊断文献报道。结果腹部B超检查肝右叶可见中强回声区，边界清晰，其内部回声不均并见少量液化区。 CT平扫可见肝实质混杂密度肿块，肿块内见片状高密度区和低密度区，肿块边缘见不规则软组织成分；增强检查显示肿块边缘软组织密度于肝动脉期强化，门静脉期和平衡期相对于肝实质强化程度降低，高密度和低密度区无强化。手术病理学检查为低分化肝细胞癌合并瘤内出血。结论肝脏肿块内自发出血少见，全面观察肿块，识别肿块内的软组织成分是鉴别诊断关键。%Objective To illustrate the CT findings of a case of hemorrhagic hepatocellular carcinoma and to review the literature of differentiation of nontraumatic hemorrhagic liver masses. Method A case of hemorrhagic hepatocellullar carcinoma was analysed and literatures were reviewed. Results Abdominal ultrasound revealed a well -defined heteroechonic area with liquified foci in the right lobe of liver. Precontrast CT scan revealed a heterogeneously dense mass in the right lobe of liver. There was hyperdense and hypodense areas in the mass and irregular soft tissue in the margin of the mass. Contrast enhanced CT scan showed the margin with soft tissue density enhanced in the hepatic arterial phase, but it decreased in the portal phase and delayed phase. The hyperdense and hypodense areas had no enhancement. Histopathology showed poorly differentiated hepatocellular carcinoma invaded the capsule. Immunohistochemistry showed hepatocyte positive and AFP negative. Conclusion Spontaneous bleeding of hepatic tumor is a rare condition. The key to distinguish is to observe the mass comprehensively and to identify the soft tissue carefully in the mass.
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