title: Usefulness of contrast-enhanced ultrasonography in the diagnosis of ruptured hepatocellular carcinoma.
abstract: The identification of bleeding sites of ruptured hepatocellular carcinoma (HCC) is important for immediate treatment. We experienced a case of ruptured HCC readily treated with transarterial embolization (TAE) after identification of the bleeding site using contrast-enhanced ultrasonography (CEUS) with Sonazoid. We report the case of a 61-year-old male with multiple HCCs caused by alcohol-related cirrhosis, who was admitted for rapid development of abdominal fullness. The diagnosis was established by hemorrhagic ascites by abdominal paracentesis. No clear extravasation was found on contrast-enhanced computed tomography. CEUS using the re-injection method in the post-vascular phase showed active bleeding from a lesion close to the S5 gallbladder bed. Abdominal angiography was urgently performed. Based on CEUS findings, selective cannulation of the cystic artery was performed. Cystic angiography findings with carbon dioxide showed extravasation. He was treated by TAE. Our case had multiple HCCs, but CEUS was useful for the identification of bleeding sites.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Medical Center, Omori Hospital 6-11-1, Omorinishi, Ota-ku, Tokyo, 143-8541 Japan.
authors.forename: Kazue
authors.initials: K
authors.lastname: Shiozawa
authors.forename: Manabu
authors.initials: M
authors.lastname: Watanabe
authors.forename: Takashi
authors.initials: T
authors.lastname: Ikehara
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Matsukiyo
authors.forename: Koji
authors.initials: K
authors.lastname: Ishii
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Igarashi
authors.forename: Yasukiyo
authors.initials: Y
authors.lastname: Sumino
keywords: Contrast-enhanced ultrasonography; Hepatocellular carcinoma; Rupture; Sonazoid; Transarterial embolization