Sugihara Takaaki, Koda Masahiko, Okamoto Toshiaki, Miyoshi Kenichi, Matono Tomomitsu, Isomoto Hajime
Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, 683-8504, Japan.
J Med Ultrason (2001). 2018 Apr;45(2):319-323. doi: 10.1007/s10396-017-0812-7. Epub 2017 Aug 16.
Spontaneous rupture is a life-threatening complication of hepatocellular carcinoma (HCC). Detecting active bleeding is critical. Color Doppler and contrast-enhanced ultrasonography (CEUS) with Levovist are reported to be useful for detecting active bleeding. A few reports have described using Sonazoid to detect bleeding in ruptured HCC. This report describes two distinctive patterns of bleeding from ruptured HCC observed in CEUS with Sonazoid. Four patients with suspected HCC rupture were examined by gray-scale ultrasonography (US) and then CEUS with Sonazoid. Two patterns of bleeding were observed with CEUS: jet-like extravasation (n = 2) and bubble leakage (n = 2). While contrast-enhanced computed tomography and angiography revealed active bleeding in only one patient, CEUS detected active bleeding and enabled the bleeding site to be estimated in all patients. Transcatheter arterial embolization was performed based on the findings of CEUS, and hemostasis was achieved in all patients. CEUS using Sonazoid could demonstrate active bleeding as two patterns, and these findings enabled us to detect the rupture site of HCC more confidently than with other modalities.
自发性破裂是肝细胞癌（HCC）的一种危及生命的并发症。检测活动性出血至关重要。据报道，彩色多普勒和使用声诺维的对比增强超声（CEUS）有助于检测活动性出血。有少数报告描述了使用Sonazoid检测破裂性HCC中的出血情况。本报告描述了在使用Sonazoid的CEUS中观察到的破裂性HCC的两种独特出血模式。对4例疑似HCC破裂的患者进行了灰阶超声（US）检查，然后进行了使用Sonazoid的CEUS检查。在CEUS中观察到两种出血模式：喷射状外渗（n = 2）和气泡渗漏（n = 2）。虽然对比增强计算机断层扫描和血管造影仅在1例患者中显示有活动性出血，但CEUS在所有患者中均检测到了活动性出血并能够估计出血部位。根据CEUS的检查结果进行了经导管动脉栓塞术，所有患者均实现了止血。使用Sonazoid的CEUS能够将活动性出血显示为两种模式，这些发现使我们比使用其他检查方法更有信心地检测到HCC的破裂部位。
