A Bleeding Liver Tumor

Clinical presentation: A 33-year-old female patient presented with acute, abdominal right upper-quadrant pain, referred to the right shoulder. She had not vomited and her stools were normal. Her previous history was unremarkable. She had been taking oral contraceptives for the past 10 years, but otherwise had no medication. Physical examination: Her pulse rate was raised, but temperature and blood pressure were normal. Both upper abdominal quadrants were painful on palpation, but there was no abdominal rigidity or tenderness. Liver dullness was present on percussion. Laboratory tests: The laboratory results showed slightly abnormal liver function tests (AST 40 U/l, alkaline phosphatase 100 U/l, A-GT 60 U/l). The hemoglobin content of the blood was below normal (5.2 mmol/l), with normal coagulation parameters. The leukocyte count was elevated (11 ! 109/l) while serum amylase was normal.