Introduction

Hepatocellular adenomas are uncommon benign liver tumors occurring predominantly in women of reproductive age and are associated with exposure to exogenous estrogens and metabolic risk factors. Their main complications are hemorrhage and, less frequently, malignant transformation. The risk of hemorrhage is influenced by lesion size and molecular subtype [[1], [2], [3]].

Multimodality imaging plays a central role in detecting intralesional hemorrhage and associated hematomas, demonstrating lesion multiplicity, assessing for active contrast extravasation, and guiding therapeutic management. In hemodynamically stable patients with hemorrhagic hepatocellular adenomas, selective arterial embolization may achieve bleeding control while preserving uninvolved liver parenchyma [4].

We present a case of multifocal hemorrhagic hepatocellular adenomas occurring immediately after vigorous physical exertion, illustrating the role of clinical, laboratory, and imaging findings in guiding selective arterial embolization despite the absence of definite active contrast extravasation on CT.