Computed tomographic findings of ruptured hepatic malignancy

Kim, Pyo Nyun; Kim, Il Young; Bae, Wong Kyung; Lee, Byoung Ho

doi:10.1007/bf01887382

Cited by 12 publications

(8 citation statements)

References 18 publications

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“…Shock is present in 33–90% of patients . The rate of clinical diagnosis of ruptured HCC has gradually improved owing to the development of imaging modalities such as ultrasonography (US) and computed tomography (CT); in previous studies, 75% of the diagnoses were confirmed by CT, US or both . However, some cases are still initially diagnosed on emergency exploratory laparotomy .…”

Section: Introductionmentioning

confidence: 99%

Spontaneous ruptured hepatocellular carcinoma

Yoshida

Mamada

Taniai

et al. 2015

Hepatology Research

108

143

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The incidence of hepatocellular carcinoma (HCC) is rising worldwide. Spontaneous rupture of HCC occasionally occurs, and ruptured HCC with intraperitoneal hemorrhage is potentially life-threatening. The most common symptom of ruptured HCC is acute abdominal pain. The tumor size in ruptured HCC is significantly greater than that in non-ruptured HCC, and HCC protrudes beyond the original liver margin. In the acute phase, hemostasis is the primary concern and tumor treatment is secondary. Transcatheter arterial embolization (TAE) can effectively induce hemostasis. The hemostatic success rate of TAE ranges 53-100%. A one-stage surgical operation is a treatment modality for selected patients. Conservative treatment is usually given to patients in a moribund state with inoperable tumors and thus has poor outcomes. Patients with severe ruptures of advanced HCC and poor liver function have high mortality rates. Liver failure occurs in 12-42% of patients during the acute phase. In the stable phase, tumor treatment, such as transarterial chemoembolization or hepatic resection should be concerned. The combination of acute hemorrhage and cancer in patients with ruptured HCC requires a two-step therapeutic approach. TAE followed by elective hepatectomy is considered an effective strategy for patients with ruptured HCC.

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Section: Introductionmentioning

confidence: 99%

Spontaneous ruptured hepatocellular carcinoma

Yoshida

Mamada

Taniai

et al. 2015

Hepatology Research

108

143

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“…Doppler ultrasound and CT imaging are useful in delineating hemoperitoneum and liver tumors and CT is specifically useful in detecting HCC rupture by visualizing the tumor and blood loss. The peripheral location and protrusion of the tumor and discontinuity of the hepatic surface and surrounding hematoma with high attenuation on CT are very helpful signs in the diagnosis of ruptured HCC [16]. In this case study, contrast extravasation of the tumor and pooling of blood at the periphery of the liver due to hemoperitoneum were helpful in establishing the diagnosis.…”

Section: Discussionmentioning

confidence: 79%

One stage resection of spontaneous rupture of hepatocellular carcinoma in the triangular ligament with diaphragm invasion: case report and review of the literature

2012

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A spontaneous rupture of hepatocellular carcinoma (HCC) can lead to extensive hemorrhage and is a rare but life-threatening event. A 58-year-old male patient with no history of trauma presented at our institution with severe epigastric pain and abdominal distension for 6 h. His blood pressure was a 60/40 mmHg, and pulse rate was 132/min. Abdominal contrast enhanced computed tomography (CT) imaging revealed a ruptured mass under the left diaphragm and fluid collection in the upper abdomen, flanks and pelvic cavity. Exploratory laparotomy confirmed the presence of an active bleeding tumor in the triangular ligament invading into the diaphragm. The tumor was resected with an appropriate diaphragm margin. The resected tumor was 5 cm in diameter and pathologically identified as hepatocellular carcinoma with a negative surgical margin. This case report shows that ruptured hepatocellular carcinoma should be considered in the differential diagnosis of non-traumatic hemoperitoneum. And it is necessary to set a surgical plan for unpredictable HCC rupture with direct diaphragm invasion.

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“…Ac- we could not confirm whether the sentinel vessels were occluded hepatic veins or injured feeding arteries. We presumed that the sentinel vessels were injured feeding arteries, based on previous evidence of vascular injury in ruptured HCCs (17,(21)(22)(23)(24).…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have suggested that HCC rupture is caused by the disruption of friable feeding arteries, leading to hemorrhage and increased intra-tumoral pressure from the local bleed (8,9,(14)(15)(16)(17)(18). During hepatic angiography, we have previously observed that ruptured HCCs are associated with disproportionately in whom TAE were not performed.…”

Section: Introductionmentioning

confidence: 99%

Hepatic Angiographic Findings of Ruptured Hepatocellular Carcinoma: "Sentinel Signs" versus Extravasation

Yun

Nam

2014

J Korean Soc Radiol

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This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.Purpose: This study retrospectively compared the accuracy of angiographic sentinel signs (sentinel vessels, hypovascular areas, and delayed dots) with extravasation in the diagnosis of ruptured hepatocellular carcinoma (HCC). Materials and Methods: Sixteen patients diagnosed with HCC between March 2007 and November 2011 were evaluated. Among the patients, we identified 32 HCCs (19 ruptured, 13 unruptured), and assessed all HCCs by hepatic angiography with regard to extravasation, sentinel vessels, hypovascular areas, and delayed dots. We compared the sensitivity and specificity of the sentinel signs with those of the extravasation for the diagnosis of a ruptured HCC. Results: For the angiographic diagnosis of a ruptured HCC, the sensitivity of the sentinel signs (sentinel vessel, 63.2%; hypovascular area, 89.5%; delayed dot, 72.7%) was higher than the sensitivity of extravasation (15.8%). The difference in sensitivity between each sentinel sign and extravasation was statistically significant (sentinel vessel, p = 0.012; hypovascular area, p < 0.001; delayed dot, p = 0.039). The specificity of sentinel signs for the diagnosis of ruptured HCC was not statistically different from the specificity of extravasation. Conclusion: Sentinel signs are more accurate than extravasation for the angiographic diagnosis of a ruptured HCC.

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Computed tomographic findings of ruptured hepatic malignancy

Cited by 12 publications

References 18 publications

Spontaneous ruptured hepatocellular carcinoma

Spontaneous ruptured hepatocellular carcinoma

One stage resection of spontaneous rupture of hepatocellular carcinoma in the triangular ligament with diaphragm invasion: case report and review of the literature

Hepatic Angiographic Findings of Ruptured Hepatocellular Carcinoma: "Sentinel Signs" versus Extravasation

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