A 58-year-old white woman was admitted to Sinai Hospital of Detroit in May 1981 with complaints of substernal pain radiating to the right upper abdominal quadrant and right shoulder. An episode of chest pain two months prior to admission had been diagnosed as pulmonary embolism,, and warfarin was used to elevate the prothrombin time to a therapeutic range. The other medication taken included liotrix for hypothyroidism. A modified radical mastectomy was performed for a diagnosis of adenocarcinoma of the right breast in October 1977. One of 17 axillary lymph nodes dissected was positive for metastasis. The estrogen receptor protein was elevated to 53.3 fmol at that time. The chest x-ray, metastatic bone survey, and liver scan were normal. There was no history of alcohol abuse, jaundice, blood transfusion, trauma, nor treatment with any androgenic steroid. The physical examination on the present admission revealed that the woman had stable vital signs. The abdomen was soft, nondistended, with no guarding or rigidity, but with tenderness in the upper right quadrant. No organs or masses were palpable, and there were no signs of external blood loss. Shortly after admission, however, the blood pressure dropped, and deep clinical shock developed. Her hemoglobin dropped from 14 g/dL to 10.3 g/dL. On admission, surgical consultation was obtained, and the following studies were done: SMA-12, electrolytes, CPK, chest x-ray, and electrocardiogram results were within normal limits. Ventilation perfusion scan of the lungs showed no defects. Flat films of the abdomen indicated peritoneal fluid. The patient was taken to surgery, where a massive rupture of the right lobe of liver was found. Right lobe hepatectomy was done and the hepatic bed packed with gel foam. The patient had a stormy postoperative course. Vital signs could not be maintained, in spite of transfusions of 13 units of blood, 3 units of fresh frozen plasma, and platelets. She died 36 hours postoperatively.