Weinberg Laurence, Abu-Ssaydeh Diana, Macgregor Chris, Wang Jason, Wong Clarence, Spanger Manfred, Muralidharan Vijayragavan
Department of Anaesthesia, Austin Hospital, Heidelberg, Victoria, 3084, Australia; Department of Surgery, University of Melbourne, Austin Health, 8002, Victoria, Australia.
Department of Anaesthesia, Austin Hospital, Heidelberg, Victoria, 3084, Australia.
Int J Surg Case Rep. 2017;39:324-327. doi: 10.1016/j.ijscr.2017.08.057. Epub 2017 Sep 5.
Diagnosis of hepatocellular carcinoma (HCC) can be established with near certainty by correlating radiological imaging with clinical presentation. However, in the absence of diagnostic certainty, biopsy of liver tissue is mandatory for optimal management. We present our management of a patient with advanced liver disease who presented with an IVC mass extending into the right atrium, with co-existing liver lesions not meeting criteria for an imaging diagnosis of HCC.
A 62-year-old male with Child-Pugh C liver cirrhosis presented with decompensated liver failure. Multiple imaging modalities demonstrated an inferior vena cava (IVC) mass extending into the right atrium with co-existing liver lesions not meeting radiological criteria for an imaging diagnosis of HCC. There was no contiguous evidence of HCC in the liver, yet there was extensive tumour burden in the IVC representing a separate metastatic lesion without any indication of direct tumour spread. Under fluoroscopic and angiographic guidance, a biopsy catheter was advanced through the right atrium into the IVC. Histology from the biopsy demonstrated fragments of malignant tumour with features consistent with moderately differentiated HCC without thrombus. Given the poor prognosis associated with metastatic HCC with IVC and intracardiac involvement, a multidisciplinary decision was made with the patient's family for palliation care.
Transjugular biopsy of IVC masses can be performed effectively, in an awake patient, without the need for sedation or anaesthesia. Where multiple imaging modalities fail to confirm a diagnosis for liver or IVC pathology, transluminal biopsy can assist with definitive diagnosis and treatment planning.
通过将放射影像学检查结果与临床表现相结合，肝细胞癌（HCC）的诊断几乎可以确定。然而，在诊断不明确的情况下，肝组织活检对于优化治疗方案是必不可少的。我们介绍了对一名晚期肝病患者的治疗情况，该患者表现为下腔静脉肿块延伸至右心房，同时存在的肝脏病变不符合HCC影像学诊断标准。
一名62岁男性，Child-Pugh C级肝硬化，出现失代偿性肝衰竭。多种影像学检查显示下腔静脉（IVC）肿块延伸至右心房，同时存在的肝脏病变不符合HCC影像学诊断标准。肝脏中没有连续的HCC证据，但IVC中有广泛的肿瘤负荷，代表一个单独的转移病灶，没有任何直接肿瘤扩散的迹象。在荧光镜和血管造影引导下，将活检导管经右心房推进至IVC。活检组织学检查显示恶性肿瘤碎片，其特征与中度分化的HCC一致，无血栓形成。鉴于伴有IVC和心脏内受累的转移性HCC预后较差，与患者家属共同做出了进行姑息治疗的多学科决定。
对于IVC肿块，可在清醒患者中有效进行经颈静脉活检，无需镇静或麻醉。当多种影像学检查未能确诊肝脏或IVC病变时，经腔活检有助于明确诊断和制定治疗计划。
