Major arterioportal shunt caused by hepatocellular carcinoma.
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.
Mamada
Yasuhiro
Y
Surgery for Organ Function and Biological Regulation, Graduate School of Medinine, Nippon Medical School, Tokyo, Japan. mamachan@nms.ac.jp
Yoshida
Hiroshi
H
Taniai
Nobuhiko
N
Bandou
Kouichi
K
Mizuguchi
Yoshiaki
Y
Kakinuma
Daisuke
D
Ishikawa
Yoshinori
Y
Akimaru
Koho
K
Tajiri
Takashi
T
Naito
Zenya
Z
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