• Xiaoqian Cui, Min Zhang, Debiao Song, and Jiakun Tian.
• Department of Critical Care Medicine, The Second Hospital of Jilin University, Changchun, Jilin, China.
• Medicine (Baltimore). 2024 Sep 27; 103 (39): e39800e39800.

RationaleHepatic angiosarcoma (HSA) has a poor prognosis. Our understanding of its clinical features, diagnosis, treatment, and prognosis remains limited. In certain cases, vascular tumors such as HSA can induce bleeding complications due to thrombocytopenia, known as Kasabach-Merritt syndrome (KMS). When KMS symptoms occur in the lungs, its clinical manifestations closely resemble those of ARDS, leading to misdiagnosis and poor outcomes. Unfortunately, this condition is extremely rare and there is a lack of relevant case reports, which further adds to the difficulty of its diagnosis and treatment.Patient ConcernsThis case report describes a patient who initially presented with symptoms of ARDS. Due to the unique nature of these symptoms, the patient underwent a complex diagnostic and treatment process before finally being diagnosed with HSA complicated by KMS through pathological examination.DiagnosesThe patient was eventually diagnosed with HSA by pathology and KMS with multiorgan hemorrhage.InterventionsHighly misleading clinical manifestations were recorded during the diagnosis and treatment, which, to our knowledge, have not been previously reported.OutcomesThe patient died from a massive pulmonary hemorrhage.LessonsDysfunction of a single organ or system may be the external manifestation of a multi-system clinical disease. Therefore, in the clinical diagnosis and treatment process, especially during early diagnosis, while it is important to focus on the primary or typical clinical symptoms, it is equally crucial not to underestimate or ignore accompanying symptoms that lack specificity. When diagnosis and treatment reach an impasse, these "atypical" symptoms often prove to be key in solving the puzzle.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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