Subcapsular Liver Hematoma Following Tenecteplase Thrombolysis for ST-Segment Elevation Myocardial Infarction: A Case Report

Abstract

Subcapsular hepatic haematoma is an uncommon and potentially serious bleeding complication following systemic thrombolytic therapy. Although rare, it may occur even in the absence of trauma and can present with non-specific abdominal symptoms, making diagnosis challenging in the post-thrombolysis setting. We report the case of a 62-year-old male smoker who presented with an inferior ST-segment elevation myocardial infarction complicated by ventricular fibrillation shortly after admission. Following successful defibrillation and stabilisation, the patient received 50 mg of tenecteplase within 4 hours and 30 minutes of symptom onset, in addition to dual antiplatelet therapy and anticoagulation. Coronary angiography performed the following day revealed triple-vessel coronary artery disease, and coronary artery bypass grafting was planned. Seventy-two hours later, the patient developed abdominal pain associated with abdominal and upper limb ecchymosis while remaining haemodynamically stable. Laboratory tests showed stable haemoglobin levels with elevated liver enzymes and cholestasis. Abdominal ultrasonography revealed a large hyperechoic hepatic lesion, and computed tomography confirmed a subcapsular haematoma of the right hepatic lobe (segments VI, VII, and VIII), measuring 45.8 mm in axial diameter, with compression of the bile ducts and no evidence of intestinal perforation. There was no history of abdominal trauma. Anticoagulation was discontinued, and the patient was managed conservatively with close clinical and radiological monitoring. Follow-up CT after seven days demonstrated a reduction in haematoma size. This case highlights the importance of considering subcapsular hepatic haematoma in patients who develop abdominal pain after thrombolytic therapy, even in the absence of haemodynamic instability or a substantial decrease in haemoglobin. Early recognition and appropriate imaging are essential to ensure timely diagnosis and guide conservative management in selected stable patients.