Funatsu K, Nishihara H, Tabuchi E, Nozaki Y, Takano K, Katsuragi M, Sugihara S, Ide K, Uchino Y, Tomoda N
Department of Gastroenterology, St. Mary's Hospital, Kurume, Japan.
Kurume Med J. 1994;41(2):109-16. doi: 10.2739/kurumemedj.41.109.
A 69-year-old female was admitted to our hospital for further examination of an intrahepatic mass which had been found while undergoing a complete physical examination. The mass measured 4 cm in size and was located in the medial segment (S4) of the liver. On computed tomography (CT), S4 was observed to be 'atrophied' and was well enhanced segmentally. A celiac angiogram showed segmental staining, and a transarterial portogram demonstrated portal stoppage of S4 from the left branch. However, no segmental intensity difference was seen on magnetic resonance imaging (MRI). An aspiration biopsy showed adenocarcinoma and thus an operation was performed under a tentative diagnosis of intrahepatic cholangiocarcinoma. The postoperative diagnosis of the tumor was combined hepatocellular and cholangiocellular carcinoma. However, no histological abnormality was seen in S4, contrary to the expectation of Zahn's infarct. In this study, we discuss the mechanism and imaging findings of Zahn's infarct, the possible reasons as to why no pathological change was seen in S4, as well as stress the rarity of reports on Zahn's infarct in cases of portal thrombus due to hepatocellular carcinoma.
一名69岁女性因在全面体检时发现肝内肿块而入院接受进一步检查。该肿块大小为4厘米，位于肝脏的内侧段（S4）。在计算机断层扫描（CT）上，观察到S4呈“萎缩”状态，且有节段性强化。腹腔动脉造影显示节段性染色，经动脉门静脉造影显示S4从左支出现门静脉阻塞。然而，在磁共振成像（MRI）上未发现节段性强化差异。穿刺活检显示为腺癌，因此在初步诊断为肝内胆管癌的情况下进行了手术。肿瘤的术后诊断为肝细胞癌和胆管细胞癌合并。然而，与扎恩梗死的预期相反，在S4中未发现组织学异常。在本研究中，我们讨论了扎恩梗死的机制和影像学表现、S4中未出现病理变化的可能原因，以及强调肝细胞癌导致门静脉血栓形成病例中扎恩梗死报告的罕见性。
