Conclusion

Multifocal hepatocellular adenomas may be complicated by clinically significant intralesional hemorrhage and an associated subcapsular hematoma, even in the absence of definite active contrast extravasation on CT. In this setting, management should be guided by the integration of multimodality imaging with serial clinical and laboratory findings rather than by imaging evidence of active bleeding alone. Persistent hemoglobin decline and worsening abdominal pain may justify selective arterial embolization, which can achieve effective hemostasis while preserving uninvolved liver parenchyma. Careful assessment of all hepatic lesions is also essential, as hemorrhagic changes may involve smaller adenomas and help establish the multifocal nature of the disease.