Clinical efficacy of contrast-enhanced ultrasonography (CEUS) in the diagnosis of ruptured hepatocellular carcinoma (HCC)

Matsumoto, Naoki; Ogawa, Masahiro; Nakagawara, Hiroshi; Hiroi, Yoshikazu; Yamamoto, Takeshi; Arakawa, Yasuyuki; Ishida, Hideaki; Komatsuda, Tomoya; Yamada, Mamiko; Yagisawa, Hitoshi

doi:10.1007/s10396-007-0136-0

Cited by 9 publications

(9 citation statements)

References 10 publications

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“…This is because CECT has superior spatial resolution, but requires a certain period of time for imaging. Several recent reports have suggested that CEUS with Levovist (Schering, Berlin, Germany) or Sonazoid may also be useful for this purpose [2, 3]. In 10 patients with ruptured HCC who underwent CEUS with Levovist and abdominal angiography, Matsumoto et al [2] found that CEUS could be used to differentiate active hemorrhage from inactive hemorrhage by examining the contrast agent in ascites.…”

Section: Discussionmentioning

confidence: 99%

“…Several recent reports have suggested that CEUS with Levovist (Schering, Berlin, Germany) or Sonazoid may also be useful for this purpose [2, 3]. In 10 patients with ruptured HCC who underwent CEUS with Levovist and abdominal angiography, Matsumoto et al [2] found that CEUS could be used to differentiate active hemorrhage from inactive hemorrhage by examining the contrast agent in ascites. Sugihara et al [3] found that CEUS with Sonazoid was effective for identification of the bleeding site in a hepatic surface after radiofrequency ablation (RFA) based on a jet-like high-intensity echo in pleural effusion, although the findings could not be confirmed with color Doppler imaging.…”

Section: Discussionmentioning

confidence: 99%

“…Contrast-enhanced ultrasonography (CEUS) is a non-invasive alternative approach that may be useful for identification of bleeding sites [2, 3]. We experienced a case of ruptured HCC that developed as a complication of alcohol-related cirrhosis.…”

Section: Introductionmentioning

confidence: 99%

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Usefulness of contrast-enhanced ultrasonography in the diagnosis of ruptured hepatocellular carcinoma

Shiozawa

Watanabe

Ikehara

et al. 2013

Clin J Gastroenterol

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The identification of bleeding sites of ruptured hepatocellular carcinoma (HCC) is important for immediate treatment. We experienced a case of ruptured HCC readily treated with transarterial embolization (TAE) after identification of the bleeding site using contrast-enhanced ultrasonography (CEUS) with Sonazoid. We report the case of a 61-year-old male with multiple HCCs caused by alcohol-related cirrhosis, who was admitted for rapid development of abdominal fullness. The diagnosis was established by hemorrhagic ascites by abdominal paracentesis. No clear extravasation was found on contrast-enhanced computed tomography. CEUS using the re-injection method in the post-vascular phase showed active bleeding from a lesion close to the S5 gallbladder bed. Abdominal angiography was urgently performed. Based on CEUS findings, selective cannulation of the cystic artery was performed. Cystic angiography findings with carbon dioxide showed extravasation. He was treated by TAE. Our case had multiple HCCs, but CEUS was useful for the identification of bleeding sites.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Usefulness of contrast-enhanced ultrasonography in the diagnosis of ruptured hepatocellular carcinoma

Shiozawa

Watanabe

Ikehara

et al. 2013

Clin J Gastroenterol

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“…There are only few studies of Contrast Enhanced Ultrasound (CEUS) in the diagnosis of ruptured HCC. [65][66][67] In a small series of 10 patients with ruptured HCC, CEUS has sensitivity, specificity and diagnostic accuracy of 75%, 50% and 60% respectively, compared to conventional angiography. 65 It can reliably differentiate between active leaks from non-active bleeding by demonstrating contrast extravasation into the ascites.…”

Section: Contrast Enhance Ultrasonography (Ceus)mentioning

confidence: 99%

Rupture of Hepatocellular Carcinoma: A Review of Literature

Sahu

Chawla

Dhiman

et al. 2019

Journal of Clinical and Experimental Hepatology

110

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Approximately 700,000 people die of Hepatocellular Carcinoma (HCC) each year worldwide, making it the third leading cause of cancer related deaths. Rupture is a potentially life-threatening complication of HCC. The incidence of HCC rupture is higher in Asia and Africa than in Europe. In Asia approximately 10% of patients with a diagnosis of HCC die due to rupture each year. Spontaneous rupture is the third most common cause of death due to HCC after tumor progression and liver failure. The diagnosis of rupture in patients without history of cirrhosis or HCC may be difficult. The most common symptom of ruptured HCC is abdominal pain (66-100%). Shock at presentation can be seen in 33-90% of cases; abdominal distension is reported in 33%. Abdominal paracentesis documenting hemoperitoneum is a reliable test to provisionally diagnose rupture of HCC, it can be seen in up to 86% of clinically suspected cases. The diagnoses can be confirmed by computed tomography scan or ultrasonography, or both in 75% of cases. Careful pre-treatment evaluation is essential to decide the best treatment option. Management of ruptured HCC involves multidisciplinary care where hemostasis remains a primary concern. Earlier studies have reported a mortality rate of 25-75% in the acute phase of ruptured HCC. However, recent studies have reported a significant decrease in the incidence of mortality. There is also a decrease in the incidence of ruptured HCC due to improved surveillance and early detection of HCC. Transarterial Embolization is the least invasive method to effectively induce hemostasis in the acute stage with a success rate of 53-100%. Hepatic resection in the other hand has the advantage of achieving hemostasis and in the same go offers a potentially curative resection in selected patients. (J CLIN EXP HEPATOL 2019;9:245-256) INCIDENCE The reported incidence of HCC rupture shows a distinct global variation. In the West, the incidence of HCC is increasing but HCC ruptures are relatively uncommon, with an incidence of less than 3%. 12-14 However, in Asia and Africa, the incidence is considerably higher, ranging between 3% and 26%. 14,15 The incidences of ruptured HCC reported from around the globe are 10% from Japan, 12.4% from Thailand, 12.7% from southern Africa, 14.5% from

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“…[1][2][3] The patient showed a dramatic decrease in the pressure gradient in the outfl ow tract on the injection of ethanol. Myocardial contrast enhancement of the localized area promised a successful result following ethanol injec- Keywords percutaneous transluminal septal myocardial ablation (PTSMA) · contrast echo · hypertrophic obstructive cardiomyopathy…”

Section: Discussionmentioning

confidence: 97%

Percutaneous transluminal septal myocardial ablation for hypertrophic obstructive cardiomyopathy

et al. 2008

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Katsufumi MIZUSHIGE · Kazushi MURAKAMI Teppei TSUJI · Isao KONDO · Xie LU Atsufumi TOMOHIROPercutaneous transluminal septal myocardial ablation for hypertrophic obstructive cardiomyopathy was carefully introduced into a small branch perforating the hypertrophic site of the interventricular septum. Contrast agent produced using the manual agitation method was injected from the tip of the balloon catheter. Simultaneously, a left ventricular long-axis view from the cardiac apex was taken with a low gain setting of the ultrasonograph. The hypertrophic site of the interventricular septum was visualized as a brightened mass (Fig. 2) immediately after the echo contrast agent was injected. Ethanol was slowly injected through the tip of the balloon catheter superselectively inserted into the perforating branch of the LAD.During the follow-up period, reduction of the pressure gradient in the left ventricular outfl ow tract was demonstrated on continuous-wave Doppler fl owmetry and two-dimensional echocardiography (Fig. 3). Systolic anterior motion disappeared on M-mode echocardiography, although the aortic regurgitation jet image became clearer than that acquired at the time of the preoperative examination. The grade of regurgitation was not suffi cient to infl uence the clinical course. DiscussionPercutaneous transluminal septal myocardial ablation (PTSMA) is a semi-invasive treatment using a catheter technique in patients with hypertrophic obstructive cardiomyopathy. The success rate of this method depends on the location of the hypertrophic site. In our patient, the hypertrophic site was extremely localized in the outfl ow tract of the interventricular septum. Since myocardial damage can be limited in a small area, we were able to avoid any advanced event of bradyarrhythmia or fatal damage of left ventricular function.Myocardial contrast echocardiography is feasible as a method for deciding an adequate area for injection of ethanol. 1-3 The patient showed a dramatic decrease in the pressure gradient in the outfl ow tract on the injection of ethanol. Myocardial contrast enhancement of the localized area promised a successful result following ethanol injecKeywords percutaneous transluminal septal myocardial ablation (PTSMA) · contrast echo · hypertrophic obstructive cardiomyopathy Case presentationA 69-year-old woman was referred to our hospital because of dyspnea and a sensation of pressure in her chest during exertion. She had been under treatment with a Ca channel blocker and diuretics for systemic hypertension. Her blood pressure was 120/60 mmHg and her pulse rate was 84 beats/ min. Cardiac examination revealed a grade III/VI systolic ejection murmur in the 4th left sternal border. An electrocardiogram showed normal sinus rhythm and left ventricular hypertrophy, and a chest X-ray fi lm showed mild cardiomegaly. Transthoracic echocardiography was carried out. Localized hypertrophy of the interventricular septum produced a marked obstruction in the left ventricular outfl ow tract, and systolic anterior motion was reveal...

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Clinical efficacy of contrast-enhanced ultrasonography (CEUS) in the diagnosis of ruptured hepatocellular carcinoma (HCC)

Abstract: CEUS allows us to differentiate active bleeding (presence of contrast medium in the ascites) from nonactive bleeding.

Cited by 9 publications

References 10 publications

Usefulness of contrast-enhanced ultrasonography in the diagnosis of ruptured hepatocellular carcinoma

Usefulness of contrast-enhanced ultrasonography in the diagnosis of ruptured hepatocellular carcinoma

Rupture of Hepatocellular Carcinoma: A Review of Literature

Percutaneous transluminal septal myocardial ablation for hypertrophic obstructive cardiomyopathy

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