Manifestations and diagnosis of hepatic hemorrhage

Bleeding from the liver can be intrahepatic or extrahepatic (subperitoneal or extraperitoneal). Bleeding can be due to trauma, surgery, puncture or due to cirrhosis, hepatocellular carcinoma, coagulation disorders and other diseases. A large amount of bleeding from the liver can be life-threatening. MRI manifestations] On MRI, the manifestations are related to the different periods of hemorrhage decomposition products. Acute hemorrhage (within 2-3 days) fluid signals consistent with intracellular deoxyhemoglobin, homogeneous signal of the accumulated fluid, low T1WI signal and obvious T2WI low signal. Subacute hemorrhage (3-5 days) shows fluid signal consistent with intracellular methemoglobin, with fluid aggregates presenting a T1WI medium-high signal and T2WI low signal image. Late hemorrhage may show central zone T1WI high signal (intracellular methemoglobin) T1WI and T2WI borderline low signal ferritin-containing hemoglobin. A. T2WI fat suppression: central high signal with peripheral thick low signal (ferritin-containing hemosiderin); B. T1WI congruent image: short T1 central high signal typical of ferritin; C. Mostly no enhancement during enhancement; D. Delayed phase: no enhancement. [Differential diagnosis] Septic liver abscess, cystic tumor, solid tumor hemorrhage.