Book contents
- Frontmatter
- Contents
- List of contributors
- Preface
- Acknowledgment
- Section 1 Head and neck
- Section 2 Thoracic imaging
- Section 3 Cardiac imaging
- Section 4 Vascular and interventional
- Case 33 Lower extremity ischemia due to homocystinuria
- Case 34 Iatrogenic pathology masquerading as an artifact
- Case 35 Fibromuscular dysplasia
- Case 36 Traumatic vertebral arteriovenous fistulae
- Case 37 Colonic perforation during intussusception reduction
- Case 38 Juvenile nasopharyngeal angioma
- Case 39 Small bowel fistula complicating perforated appendicitis: successful treatment with tissue adhesive
- Case 40 Extrahepatic collateral arterial supply to hepatocellular carcinoma
- Case 41 Use of a curved needle to access an otherwise inaccessible abscess
- Case 42 Umbilical venous catheter malposition
- Case 43 Middle aortic syndrome
- Section 5 Gastrointestinal imaging
- Section 6 Urinary imaging
- Section 7 Endocrine - reproductive imaging
- Section 8 Fetal imaging
- Section 9 Musculoskeletal imaging
- Index
- References
Case 40 - Extrahepatic collateral arterial supply to hepatocellular carcinoma
from Section 4 - Vascular and interventional
Published online by Cambridge University Press: 05 June 2014
- Frontmatter
- Contents
- List of contributors
- Preface
- Acknowledgment
- Section 1 Head and neck
- Section 2 Thoracic imaging
- Section 3 Cardiac imaging
- Section 4 Vascular and interventional
- Case 33 Lower extremity ischemia due to homocystinuria
- Case 34 Iatrogenic pathology masquerading as an artifact
- Case 35 Fibromuscular dysplasia
- Case 36 Traumatic vertebral arteriovenous fistulae
- Case 37 Colonic perforation during intussusception reduction
- Case 38 Juvenile nasopharyngeal angioma
- Case 39 Small bowel fistula complicating perforated appendicitis: successful treatment with tissue adhesive
- Case 40 Extrahepatic collateral arterial supply to hepatocellular carcinoma
- Case 41 Use of a curved needle to access an otherwise inaccessible abscess
- Case 42 Umbilical venous catheter malposition
- Case 43 Middle aortic syndrome
- Section 5 Gastrointestinal imaging
- Section 6 Urinary imaging
- Section 7 Endocrine - reproductive imaging
- Section 8 Fetal imaging
- Section 9 Musculoskeletal imaging
- Index
- References
Summary
Imaging description
Figure 40.1 depicts an axial MR image obtained in a 17-year-old female with autoimmune hepatitis. On biopsy, the mass in segment 6/7 was consistent with a well-differentiated hepatocellular carcinoma. The patient also had a solitary pulmonary nodule that on resection was consistent with a metastasis from the hepatic primary. Full workup indicated the presence of cirrhosis, portal hypertension, and decreased liver function that precluded operative resection of the tumor. Her metastasis disqualified her from orthotopic liver transplantation. Interventional radiology was consulted to perform transarterial hepatic chemoembolization (TACE) to slow the growth of the primary neoplasm. At angiography, the patient’s segment 6/7 tumor was supplied largely by branches of the right hepatic artery that were embolized to stasis with a cisplatin–doxorubicin–Lipiodol mixture. Following each of three TACE procedures over a 12-month period, the patient continued to have a portion of the tumor that failed to accumulate Lipiodol and thus remained untreated (Fig. 40.2). At a fourth TACE procedure, a right inferior phrenic arteriogram was performed (Fig. 40.3). A 2.7-French microcatheter was advanced into the ectatic, tortuous branch of the right inferior phrenic artery shown to supply the tumor, and TACE was performed. A Dyna-CT scan (Siemens Medical Solutions USA, Malvern, PA) performed immediately after TACE treatment demonstrated dense Lipiodol accumulation within the previously untreated portion of the tumor (Fig. 40.4).
- Type
- Chapter
- Information
- Pearls and Pitfalls in Pediatric ImagingVariants and Other Difficult Diagnoses, pp. 181 - 182Publisher: Cambridge University PressPrint publication year: 2014