From the Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127 Palermo, Italy.
Radiology. 2022 Oct;305(1):242-246. doi: 10.1148/radiol.210539.
A 61-year-old woman was admitted to our institution to characterize an incidentally found mass in the porta hepatis. An episode of pulmonary embolism (18 months ago) and a pulmonary abscess (15 months ago) were reported. The patient had no history of known liver disease, previous cancer diagnosis, or trauma. She underwent total thyroidectomy for goiter several years ago, with initial iatrogenic hypothyroidism treated with levo-thyroxine hormone replacement therapy. During follow-up, this therapy was adjusted (50 μg per day) to induce euthyroidism and to achieve a target serum thyroid-stimulating hormone concentration of 1-2 mIU/L. Physical examination findings were unremarkable. Admission laboratory data were entirely normal, including tumor markers, such as carcinoembryonic antigen and carbohydrate antigen 19-9. Unenhanced and multiphasic contrast-enhanced CT imaging was performed in arterial, portal venous, and delayed (3 minutes after injection) phases. Axial and coronal maximum intensity projection reconstructed CT images were obtained in the arterial and portal venous phases. Because of the imaging findings of the mass in the porta hepatis and concerns about malignancy, the patient underwent endoscopy. Therefore, endoscopic US-guided fine-needle biopsy was performed in the same session. The patient also underwent whole-body iodine 131 (I) scintigraphy.
一位 61 岁女性因偶然发现肝门处肿块而入院。患者报告曾有肺栓塞（18 个月前）和肺脓肿（15 个月前）病史。她无已知肝脏疾病、既往癌症诊断或外伤史。几年前因甲状腺肿行甲状腺全切除术，初始发生医源性甲状腺功能减退，采用左旋甲状腺素激素替代疗法治疗。随访期间，调整了该治疗方案（每天 50μg）以诱导甲状腺功能正常，并将目标血清促甲状腺激素浓度控制在 1-2mIU/L。体格检查未见异常。入院时实验室检查数据完全正常，包括肿瘤标志物如癌胚抗原和糖链抗原 19-9。进行了平扫和多期增强 CT 成像，包括动脉期、门静脉期和延迟期（注射后 3 分钟）。获得了动脉期和门静脉期的轴位和冠状位最大强度投影重建 CT 图像。由于肝门处肿块的影像学表现以及对恶性肿瘤的担忧，患者接受了内镜检查。因此，在同一次内镜超声引导下进行了细针活检。患者还进行了全身碘 131（I）闪烁扫描。
