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PITFALLS IN THE ARTERIOGRAPHIC DIFFERENTIATION OF INTRAHEPATIC AND EXTRAHEPATIC MASSES

JON D. SHANSER M.D.1, MORTON G. GLICKMAN M.D., and ALPHONSE J. PALUBINSKAS M.D.

1 Research Fellow in Diagnostic Radiology, supported by Grant GM-01272 from the National Institute of General Medical Sciences, National Institutes of Health, USPHS.

When a mass in the upper abdomen is suspected on clinical or routine roentgenographic examination, or a mass of the liver is detected by means of radioisotope study, selective abdominal arteriography has been suggested as the diagnostic method most helpful in differentiating whether the mass is intrahepatic or extrahepatic.

Our experience has shown that the arteriographic criteria suggested in the past are nonspecific and that, with careful analysis of intrahepatic arteries as well as additional oblique or lateral projections (whichever is more tangential to the site of compression), the false positive diagnosis of intrahepatic mass can often be avoided. Arteriography of adjacent organs can then be carried out to try to identify the origin and nature of the mass. The lack of superior and inferior arcing of intrahepatic arteries may serve as a sign of the extrahepatic location of a mass superimposed on the liver in the anteroposterior projection.


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