title: Major arterioportal shunt caused by hepatocellular carcinoma.
abstract: A case of hepatocellular carcinoma (HCC) causing a major arterioportal (A-P) shunt is reported. The patient exhibited massive ascites and tested positive for hepatitis B surface antigen. An abdominal computed tomography (CT) examination showed a low-density lesion in the left lobe of the liver and an A-P shunt, but no tumor stain was visible. Upper gastrointestinal endoscopy revealed severe esophageal varices. Because the tumor marker level was abnormally high, an HCC causing an A-P shunt in a cirrhotic liver background with severe esophageal varices as a result of portal hypertension was diagnosed. We performed endoscopic variceal ligation to treat the severe esophageal varices and interventional radiology treatment for the A-P shunt and HCC, but the patients condition was unchanged. Because the patients liver function gradually improved, surgical treatment was selected. The patient underwent left hepatectomy. Pathological examination revealed a poorly differentiated HCC in a cirrhotic liver background. The postoperative course was uneventful, and the patient was discharged 2 weeks after the operation. The patient subsequently underwent transcatheter arterial embolization therapy for recurrent HCC in the right lobe of the liver, but the esophageal varices disappeared.
authors: Surgery for Organ Function and Biological Regulation, Graduate School of Medinine, Nippon Medical School, Tokyo, Japan. mamachan@nms.ac.jp
authors: Yasuhiro
authors: Y
authors: Mamada
authors: Hiroshi
authors: H
authors: Yoshida
authors: Nobuhiko
authors: N
authors: Taniai
authors: Kouichi
authors: K
authors: Bandou
authors: Yoshiaki
authors: Y
authors: Mizuguchi
authors: Daisuke
authors: D
authors: Kakinuma
authors: Yoshinori
authors: Y
authors: Ishikawa
authors: Koho
authors: K
authors: Akimaru
authors: Takashi
authors: T
authors: Tajiri
authors: Zenya
authors: Z
authors: Naito
mesh_terms: D001164:Arteriovenous Fistula / Q000209:etiology; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000150:complications*; D004932:Esophageal and Gastric Varices / Q000150:complications; D006801:Humans; D008113:Liver Neoplasms / Q000098:blood supply / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging; D011859:Radiography