# Subcapsular Hepatic Hemorrhage: An Uncommon and Catastrophic Manifestation of Metastatic Melanoma

## TL;DR

This paper presents a rare case of a life-threatening liver hemorrhage caused by metastatic melanoma, emphasizing the importance of accurate diagnosis and careful management.

## Contribution

The paper contributes a detailed case report highlighting the diagnostic challenges of subcapsular hepatic hemorrhage in metastatic melanoma.

## Key findings

- Subcapsular hepatic hematoma can present with symptoms similar to aortic dissection or heart attack, leading to potential misdiagnosis.
- CT imaging is crucial for identifying hepatic metastases and subcapsular hematomas in melanoma patients.
- Conservative management may be appropriate in frail patients with advanced cancer and complications like hepatic hemorrhage.

## Abstract

Subcapsular hepatic hematoma is a rare but potentially life-threatening manifestation of metastatic melanoma, often presenting with vague abdominal pain and risk of misdiagnosis. We report a 76-year-old man with a history of malignant melanoma who presented with acute epigastric pain radiating to the right shoulder, vomiting, and a syncopal episode. While initial blood tests showed mild leukocytosis and raised lactate, a CT aorta excluded dissection but revealed multiple hepatic metastases with a large subcapsular hematoma and pulmonary nodules. A follow-up CT mesenteric angiogram demonstrated interval hematoma expansion without active bleeding, further metastatic progression, and a segmental pulmonary embolus. Owing to frailty and advanced malignancy, a multidisciplinary team recommended conservative management. This case highlights the diagnostic conundrum of hepatic hemorrhage in melanoma, which may mimic other acute pathologies such as aortic dissection or acute coronary syndrome. Prompt cross-sectional imaging, serial monitoring, and early multidisciplinary input are essential for accurate diagnosis and for balancing intervention risk against quality of life in complex oncology presentations.