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Transcatheter Arterial Embolization in the Emergency Department for Hemodynamic Instability Due to Ruptured Hepatocellular Carcinoma: Analysis of 167 Cases

Chia-Te Kung1, Ber-Ming Liu1, Shu-Hang Ng2, Tze-Yu Lee2, Yu-Fan Cheng2, Min-Chi Chen3 and Sheung-Fat Ko2

1 Department of Emergency Medicine, Chang Gung University, College of Medicine, Chang Gung Memorial Hospital–Kaohsiung Medical Center, Kaohsiung, Taiwan.
2 Department of Radiology, Chang Gung University, College of Medicine, Chang Gung Memorial Hospital–Kaohsiung Medical Center, 123 Ta-Pei Rd., Niao-Sung Hsiang, Kaohsiung Hsien, 833, Taiwan.
3 Department of Public Health and Biostatistics Consulting Center, Chang Gung University, College of Medicine, Chang Gung Memorial Hospital–Kaohsiung Medical Center, Kaohsiung, Taiwan.


Figure 1
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  		Fig. 1A —58-year-old man with hepatocellular carcinoma and history of tumor embolization who arrived in emergency department in acute abdominal pain and shock (blood pressure, 45/65 mm Hg). Contrast-enhanced CT scan of liver shows ruptured hepatocellular carcinoma in segment VI of liver with active contrast leakage (arrows) and adjacent blood clot (asterisks).

 

Figure 2
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  		Fig. 1B —58-year-old man with hepatocellular carcinoma and history of tumor embolization who arrived in emergency department in acute abdominal pain and shock (blood pressure, 45/65 mm Hg). Right hepatic angiogram obtained with coaxial microcatheter shows tortuous hepatic artery and partially embolized tumor (open arrows) with central abnormal stain (solid arrow) in inferior part of right lobe. There is no apparent contrast medium leakage to peritoneal cavity, and several partially embolized tumors are present in upper part of right lobe.

 

Figure 3
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  		Fig. 1C —58-year-old man with hepatocellular carcinoma and history of tumor embolization who arrived in emergency department in acute abdominal pain and shock (blood pressure, 45/65 mm Hg). Angiogram shows selective catheterization of feeding artery of segment VI hepatocellular carcinoma (open arrows) with central tumor stain (solid arrow) performed on basis of CT finding.

 

Figure 4
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  		Fig. 1D —58-year-old man with hepatocellular carcinoma and history of tumor embolization who arrived in emergency department in acute abdominal pain and shock (blood pressure, 45/65 mm Hg). Follow-up angiogram after subsegmental embolization confirms occlusion of feeding artery (black arrows) and absence of abnormal stain (open arrows). Blood pressure increased to 80/112 mm Hg 15 minutes after embolization. After 20 days, patient recovered and was discharged uneventfully.

 

Figure 5
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  		Fig. 2A —35-year-old man in acute abdominal pain and shock (blood pressure, 50/70 mm Hg). Contrast-enhanced liver CT shows ruptured hepatocellular carcinoma (open arrows) in segment IV with active contrast leakage (solid arrows) and adjacent blood clot (asterisks).

 

Figure 6
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  		Fig. 2B —35-year-old man in acute abdominal pain and shock (blood pressure, 50/70 mm Hg). Selective angiogram of segment IV of liver shows hypervascular liver nodule (open arrow) with active contrast extravasation (solid arrows).

 

Figure 7
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  		Fig. 2C —35-year-old man in acute abdominal pain and shock (blood pressure, 50/70 mm Hg). Follow-up angiogram after segmental embolization confirms disappearance of segment IV tumor and extravasation. Blood pressure increased to 78/125 mm Hg 15 minutes after embolization. After 18 days, patient recovered and was discharged uneventfully.

 

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