A Case of Unusual Radiological Findigs of Liver Caused by Gastric Carcinoma

Ahn, Byung Min; Lee, Bong Soo; Song, Ha Hyn; Lee, Hye Kyung; Park, Chan Wook; Kim, Hyun

Abstract

In contrast to the primary hepatocellular carcinoma, tumor thrombosis of the portal vein is rarely found in metastatic liver cancer which is frequently found in the patients with primary cancers of organs that has portal venous drainage. We recently experienced a case of hepatic metastasis of gastric carcinoma showing unusual radiological findings in a 67-year-old woman. She complained of abdominal bloating during the second phase of combined chemotherapy. Four months ago she had received pylorus preserving gastrectomy for advanced gastric cancer. The liver CT showed raiher well marginated, geographic low attenuations distrubuted along periphery of liver and thrombosis of the main portal vein. After infusion of contrast media, the major part of peripheral low attenuation became isodense to the central portion of liver. Ultrasound guided multifocal biopses revealed massive portal venous tumor thrombosis and trans-sinusoidal metastasis of gastric carcinoma which was more severe in the areas of peripheral low echogenicity where hepatic necrosis and fibrosis were observed. In conclusion, geographic attenuation difference in the liver on cross sectional images can be induced by massive portal venous thrombosis and following hepatic injury in liver metastasis from gastric carcinoma.