We present the case of a patient undergoing long-time treatment with oral anticoagulants for a severe vascular pathology who had a major subcapsular liver bleeding as well as retroperitoneal bleeding. The purpose of the paper is to present the specific characteristics of this case, to review the literature that concentrates on spontaneous bleedings and to show the role of contrast-enhanced ultrasonography as a useful, non invasive imaging method in excluding active hemorrhage and its value in the non-surgical management of the case.