Soyer P, Levesque M
Department of Radiology, Johns Hopkins Hospital, Baltimore.
Australas Radiol. 1995 Feb;39(1):90-2. doi: 10.1111/j.1440-1673.1995.tb00243.x.
A case is reported of a 36-year-old woman with haemoperitoneum due to spontaneous rupture of hepatic haemangiomatosis. Computed tomography showed a subcapsular hepatic mass in the posterior segment of the right hemiliver (subsegment 7) containing a fluid-fluid level. Magnetic resonance imaging depicted a subcapsular hepatic mass displaying an internal fluid-fluid level suggestive of haematoma. Hepatic angiography showed an intense arterial blush in the area of the subsegment 7 and permitted a subsequent and temporarily effective superselective transcatheter embolization of the subsegmental arterial branch for subsegment 7. Because of a recurrence of intraperitoneal haemorrhage 15 days after the first embolization, a new selective hepatic artery embolization was performed. However, intraperitoneal haemorrhage recurred 10 days after the second embolization, and the patient underwent resection of the posterior segments of the right hemiliver (subsegments 6 and 7). This case suggests that superselective arterial embolization, when used alone, does not provide a permanent treatment of haemoperitoneum due to spontaneous rupture of hepatic haemangiomatosis. However, this technique seems to be useful in avoiding an emergency surgery, allowing a planned hepatic resection.
报告了一例36岁女性因肝血管瘤病自发性破裂导致腹腔积血的病例。计算机断层扫描显示右半肝后段（第7段）有一个包膜下肝肿块，内有液-液平面。磁共振成像显示一个包膜下肝肿块，内部有液-液平面，提示血肿。肝血管造影显示第7段区域有强烈的动脉期造影剂充盈，并允许随后对第7段亚段动脉分支进行暂时有效的超选择性经导管栓塞。由于首次栓塞后15天腹腔内出血复发，进行了新的选择性肝动脉栓塞。然而，第二次栓塞后10天腹腔内出血再次复发，患者接受了右半肝后段（第6和7段）切除术。该病例表明，单独使用超选择性动脉栓塞不能永久性治疗肝血管瘤病自发性破裂导致的腹腔积血。然而，这项技术似乎有助于避免急诊手术，使肝切除术得以有计划地进行。
