Management of spontaneous subcapsular liver hematomas secondary to metastatic melanoma and aplastic anemia: a case report

Introduction

Spontaneous subcapsular liver hematomas are rare and carry significant morbidity, particularly in patients with advanced malignancy and severe hematological compromise. Management must balance hemostatic control with procedural risk and often requires multidisciplinary input. Presentation of case: We report a 50-year-old female with stage IV metastatic melanoma complicated by immune checkpoint inhibitor-induced aplastic anemia. She presented with a large spontaneous subcapsular hematoma arising from hepatic metastasis. Severe thrombocytopenia and immunosuppression rendered open surgery high-risk; hence, a less invasive approach was undertaken with targeted focal transarterial embolization (TAE), utilizing embolization-guidance software to selectively treat tumor-feeding vessels. Symptomatic improvement and early prevention of re-bleeding were achieved; however, recurrence from a second source prompted another round of more diffuse embolization of the right hepatic arterial supply, with good effect. Subsequent palliative liver radiotherapy aimed to reduce the risk of further re-bleeding.