Spontaneously Ruptured Hepatocellular Carcinoma: Computed Tomography-Based Assessment

Sandomenico, Fabio; Arpaia, Valerio; Rosa, Ferdinando De; Catalano, Orlando; Buonaiuto, Roberto Antonino; Notarangelo, Marianna; Iovino, Maria; Giovine, S; Brunetti, Arturo; Scaglione, Mariano

doi:10.3390/diagnostics13061021

Cited by 6 publications

(3 citation statements)

References 99 publications

(135 reference statements)

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“…Detection of focal lesions and haemorrhage is key to diagnosing an HCC rupture. 4 Iwasaki et al reported CT manifestations in 5 cases of an HCC rupture in the caudate lobe of the liver. 5 All cases showed exophytic tumours in the caudate lobe and high-attenuation haematomas in the lesser sac.…”

Section: Discussionmentioning

confidence: 99%

Perihepatic caudate lobe haematoma originating from a pancreatic pseudoaneurysm: a diagnostic dilemma

Ozaki,

Suyama,

Hamamoto

et al. 2024

BJR|Case Reports

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Despite advances in diagnostic imaging and interventional techniques, pancreatic pseudoaneurysms remain a life-threatening complication of pancreatitis. Presentation varies among patients and may include intra-abdominal, retroperitoneal, or gastrointestinal bleeding and bleeding into the pancreatic or common bile duct. We present a unique case of a 74-year-old man with a history of heavy alcohol consumption who presented with a haematoma surrounding the caudate lobe of the liver. Initially, alcoholic cirrhosis and a ruptured hepatocellular carcinoma were suspected. Therefore, transarterial embolization (TAE) of the caudate branch of the hepatic artery was performed. However, 3 months later, the patient experienced abdominal pain with a lesser sac haematoma and a seemingly interconnected pancreatic cyst. One month later, a pseudoaneurysm appeared in the pancreatic cyst. TAE was successfully performed for the pseudoaneurysm, and the patient showed no signs of recurrence during the 1-year follow-up.

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Section: Discussionmentioning

confidence: 99%

Perihepatic caudate lobe haematoma originating from a pancreatic pseudoaneurysm: a diagnostic dilemma

Ozaki,

Suyama,

Hamamoto

et al. 2024

BJR|Case Reports

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“… 10 This improvement is particularly attributed to the widespread recognition and utilization of therapeutic measures such as emergency or delayed partial hepatectomy and transcatheter arterial chemoembolization (TACE). 3 , 7 , 11 , 12 However, studies indicate that ALF accounts for more than half of the in-hospital mortality post emergency hepatectomy for SRHCC. 13 Furthermore, the incidence of liver failure following TACE can reach up to 12–34%.…”

Section: Introductionmentioning

confidence: 99%

Nomogram for Estimation of Acute Liver Failure Risk in Spontaneous Ruptured Hepatocellular Carcinoma

Zhao,

Jiang,

et al. 2023

JHC

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Acute liver failure (ALF) is a severe complication of spontaneous ruptured hepatocellular carcinoma (SRHCC) that requires accurate prediction for effective treatment strategies. We aimed to develop a predictive nomogram to estimate the risk of ALF in patients with SRHCC undergoing treatment. Patients and Methods: We performed a retrospective analysis of historical data from 284 patients diagnosed with SRHCC at the First Hospital of Jilin University over the past decade. Variables were selected through univariate and multivariate logistic regression analyses, and a predictive nomogram was constructed. We evaluated its predictive accuracy against the Child-Pugh Score, R.MELD, and ALBI by assessing discrimination, calibration, and net clinical benefit. Results: Among the 284 patients, 65 developed ALF. The risk factors identified for model development included largest tumor size (LTS), platelet counts, prolonged prothrombin time, and elevated serum α-fetoprotein levels. The nomogram exhibited high accuracy in predicting ALF risk with a C-index of 0.91 (0.87-0.95). The Delong test showed a significant difference between the nomogram and the other three models (p<0.05). The calibration curve for the nomogram fit well, and the decision curve analysis revealed superior net benefit. The optimal cut-off point for the nomogram was determined to be 40, yielding sensitivity, specificity, positive predictive value, and negative predictive value of 83.10%, 87.20%, 65.90% and 94.60%, respectively. Conclusion:The nomogram we developed provides an optimized tool for predicting ALF in SRHCC patients. Its application can help determine individual patient's risk of ALF, enabling more rational and personalized treatment strategies.

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“…Multiphasic computed tomography (CT) is the best imaging modality for diagnosing rHCC [12]. Hemoperitoneum, subcapsular hematoma, or active bleeding is typically seen.…”

Section: Introductionmentioning

confidence: 99%

Selective Arterial Embolization of Ruptured Hepatocellular Carcinoma with N-Butyl Cyanoacrylate and Lipiodol: Safety, Efficacy, and Short-Term Outcomes

Cali,

Chevallier,

Guillen

et al. 2023

JPM

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The rupture of hepatocellular carcinoma (rHCC) is uncommon but causes sudden life-threatening bleeding. Selective transarterial embolization (STAE) is an effective bleeding-control option. The optimal embolic agent is unknown, and data on the use of cyanoacrylate glue are lacking. The objective of this study was to report the outcomes of cyanoacrylate-lipiodol embolization for rHCC. We retrospectively reviewed the files of the 16 patients (14 males; mean age, 72 years) who underwent emergency cyanoacrylate-lipiodol STAE at a single center in 2012–2023 for spontaneous rHCC. All 16 patients had subcapsular HCC and abundant hemoperitoneum. The technical success rate was 94% (15/16). Day 30 mortality was 19%; the three patients who died had severe hemodynamic instability at admission; one death was due to rebleeding. Liver enzyme levels returned to baseline by day 30. No rebleeding was recorded during the median follow-up of 454 days in the 10 patients who were alive with available data after day 30. Larger prospective studies with the collection of longer-term outcomes are needed to assess our results supporting the safety and effectiveness of cyanoacrylate-lipiodol STAE for rHCC. Randomized trials comparing this mixture to other embolic agents should be performed.

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Spontaneously Ruptured Hepatocellular Carcinoma: Computed Tomography-Based Assessment

Cited by 6 publications

References 99 publications

Perihepatic caudate lobe haematoma originating from a pancreatic pseudoaneurysm: a diagnostic dilemma

Perihepatic caudate lobe haematoma originating from a pancreatic pseudoaneurysm: a diagnostic dilemma

Nomogram for Estimation of Acute Liver Failure Risk in Spontaneous Ruptured Hepatocellular Carcinoma

Selective Arterial Embolization of Ruptured Hepatocellular Carcinoma with N-Butyl Cyanoacrylate and Lipiodol: Safety, Efficacy, and Short-Term Outcomes

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