Occasionally patients who have metastatic liver disease may present with acute RUQ pain.
In patients who have diffuse metastatic disease, the pain likely is caused by swelling of the liver and stretching of the liver capsule .
Hemorrhage into a liver mass or metastasis, however, also may cause acute RUQ pain. Subcapsular hematomas or free intraperitoneal hemorrhage also may occur following rupture a liver mass.
Hepatic adenomas, hepatocellular carcinomas (HCCs), and vascular metastases are the liver masses most prone to hemorrhage. The risk of rupture is related to size and location, with larger size and subcapsular location being risk factors. subcapsular hematoma will appear as a crescentic-shaped area The mass is typically heterogenous in echotexture.
Hepatic subcapsular haematoma ultrasound images