Diagnosis of active hemorrhage from the liver with contrast-enhanced ultrasonography after percutaneous transhepatic angioplasty and stent placement for Budd-Chiari syndrome.

Active hemorrhage arising from hepatic injury can be life threatening and necessitates immediate hemostatic intervention. This situation has been encountered more commonly since the increase in percutaneous interventional procedures of the hepatobiliary system. 1 - 3 Low-mechanical index gray scale contrast-enhanced ultrasonography (CEUS) is based on the ability of microbubbles containing gases to produce real-time contrast-related gray scale images. This technique has been largely used in the evaluation of focal lesions in solid organs, which improves the lesion-to-parenchyma conspicuity. 4―6 Recently, some articles reported that CEUS could be used to reveal active post-traumatic intraparenchymal bleeding appearing as a hyperechoic jet that tends to pool dependently. 7―10 However, CEUS can also be very useful in the detection of bleeding caused by medical procedures such as interventional surgery, which usually is the most common and severe complication of most medical procedures. In this report, we present a case of CEUS diagnosis of delayed hemorrhage from the liver capsule 1 day after percutaneous transhepatic angioplasty and stent placement in a patient with Budd-Chiari syndrome. Laparotomy subsequently confirmed the diagnosis, and the bleeding site was successfully sutured.