CASE REPORT Selective Transcatheter Arterial Embolization for Treatment of Bleeding Complications or Reduction of Tumor Mass of Hepatocellular Adenomas Deha Erdogan Æ Otto M. van Delden Æ Olivier R. C. Busch Æ Dirk J. Gouma Æ Thomas M. van Gulik Published online: 29 June 2007 Ó Springer Science+Business Media, LLC 2007 Abstract Hepatocellular adenomas (HCAs) are benign liver lesions which may be complicated by spontaneous intratumoral bleeding, with or without rupture into the abdominal cavity, or malignant degeneration. Recent ad- vances in radiological interventional techniques now offer selective transcatheter arterial embolization (TAE) as an alternative approach to surgery as the initial treatment to stop the bleeding or as an elective treatment to reduce the tumor mass of the HCA. Herein, we report our initial experience using TAE in the management of HCA. Five female patients and one male patient presented with spontaneous hemorrhage of HCA. Four patients were ini- tially treated with selective TAE to stop the bleeding. In two patients in whom the bleeding stopped spontaneously, TAE was electively undertaken 1 year after presentation to reduce the tumor mass of HCAs >5 cm. Selective TAE as initial treatment in patients with spontaneous bleeding of HCA with or without rupture is effective and will change the need for urgent laparotomy to control bleeding. Selective TAE may also be used as an elective treatment to reduce the tumor mass of larger HCAs. Keywords Hepatocellular adenoma Á Hemorrhage Á Transcatheter arterial embolization Introduction Hepatocellular adenomas (HCAs) are uncommon benign liver tumors [1, 2] which usually affect woman between 15 and 45 years of age. These lesions may present with complications such as spontaneous intratumoral bleeding with or without hemiperitoneum [3], which can be life- threatening due to massive bleeding [4]. Another compli- cation is the risk of malignant transformation in HCAs, which has led to the advice to resect lesions >5 cm [5, 6]. Several authors have suggested immediate partial liver resection or perihepatic packing as initial treatment in cases of spontaneous bleeding. However, it is known that emergency liver resection is associated with a high mor- bidity and mortality [3, 7]. In recent years, selective transcatheter arterial embolization (TAE) has been applied as initial treatment in patients presenting with acute bleeding due to trauma or ruptured liver tumors. Selective TAE has also been described as an elective treatment for large HCAs in an attempt to reduce the tumor mass [8]. In this report, we describe six patients who presented with bleeding HCA. The liver bleed was successively treated by selective TEA in four patients. In two patients, who responded to conservative treatment, TAE was used to reduce the tumor mass of HCAs >5 cm. Case Report Case 1 A 35-year-old woman presented at a hospital elsewhere with acute onset of right upper abdominal pain combined with abdominal distension, nausea, and vomiting. No abdominal trauma had occurred. She had a history of oral D. Erdogan Á O. R. C. Busch Á D. J. Gouma Á T. M. van Gulik (&) Department of Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 Amsterdam, AZ, The Netherlands e-mail: t.m.vangulik@amc.uva.nl O. M. van Delden Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands 123 Cardiovasc Intervent Radiol (2007) 30:1252–1258 DOI 10.1007/s00270-007-9108-4