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. Discussion: TAE provided effective hemostasis while avoiding the risks of operative intervention in a profoundly thrombocytopenic, immunocompromised patient. This approach reflects an expanding role for interventional radiology in the acute management of complex hepatic hemorrhage. Conclusion: In selected high-risk patients, TAE can achieve bleeding control and symptom relief for spontaneous subcapsular liver hematomas. This case highlights the value of tailored, multidisciplinary management strategies in challenging surgical scenarios where operative management carries a prohibitive risk.