Discrepant imaging findings of portal vein thrombosis with dynamic computed tomography and computed tomography during arterial portography in hepatocellular carcinoma: possible cause leading to inappropriate treatment selection.
We encountered a patient with hepatocellular carcinoma who had discrepant imaging findings on portal vein thrombosis with portal phase dynamic computed tomography (CT) and CT during arterial portography (CTAP). CTAP, via the superior mesenteric artery and via the splenic artery, both showed a portal perfusion defect in the right hepatic lobe, indicating portal vein thrombosis in the main trunk of the right portal vein. Portal phase dynamic CT clearly depicted portal perfusion of the same hepatic area. Transarterial chemoembolization was successfully performed, but it was associated with severe liver injury. Clinicians should be cautious about this possible discrepancy based on imaging technique. The inaccurate evaluation of portal vein thrombosis may result in inappropriate treatment selection, which can worsen patient prognosis.
Department of Gastroenterology, Ogaki Municipal Hospital, 4-86 Minaminokawa, Ogaki, Gifu, 503-8502, Japan. hmtoyoda@spice.ocn.ne.jp.
Hidenori
H
Toyoda
Department of Gastroenterology, Ogaki Municipal Hospital, 4-86 Minaminokawa, Ogaki, Gifu, 503-8502, Japan.
Takashi
T
Kumada
Department of Gastroenterology, Ogaki Municipal Hospital, 4-86 Minaminokawa, Ogaki, Gifu, 503-8502, Japan.
Toshifumi
T
Tada
Department of Gastroenterology, Ogaki Municipal Hospital, 4-86 Minaminokawa, Ogaki, Gifu, 503-8502, Japan.
Kazuyuki
K
Mizuno
Department of Gastroenterology, Ogaki Municipal Hospital, 4-86 Minaminokawa, Ogaki, Gifu, 503-8502, Japan.
Natsuko
N
Kobayashi
Department of Gastroenterology, Ogaki Municipal Hospital, 4-86 Minaminokawa, Ogaki, Gifu, 503-8502, Japan.
Yosuke
Y
Inukai
Department of Gastroenterology, Ogaki Municipal Hospital, 4-86 Minaminokawa, Ogaki, Gifu, 503-8502, Japan.
Akira
A
Takeda
Department of Radiology, Ogaki Municipal Hospital, Ogaki, Japan.
Yasuhiro
Y
Sone
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000628:therapy; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000379:methods; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications* / Q000628:therapy; D011169:Portal Vein / Q000000981:diagnostic imaging*; D011172:Portography; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000000981:diagnostic imaging* / Q000209:etiology*
CT during arterial portography; Hepatocellular carcinoma; Portal phase dynamic CT; Portal vein thrombosis; Treatment selection