Investig Magn Reson Imaging.  2018 Sep;22(3):177-181. 10.13104/imri.2018.22.3.177.

Spontaneous Rupture of the Intraperitoneal Metastatic Hepatocellular Carcinoma: a Case Report with Magnetic Resonance Imaging Findings

Affiliations
  • 1Department of Radiology, Dankook University Hospital, Chungnam, Korea. deepva@hanmail.net

Abstract

Intraperitoneal metastatic hepatocellular carcinoma (HCC) is uncommon. Although rare, it can spontaneously rupture and cause hemoperitoneum similar to primary HCC in the liver. We present a case of intraperitoneal metastatic HCC that had spontaneously ruptured and appeared as an irregularly margined hemorrhagic mass with T1 high and T2 dark signal intensities on magnetic resonance imaging. Ruptured HCC is a life-threatening emergency with high mortality rate. Spontaneously ruptured intraperitoneal metastatic HCC should be considered if a patient with a history of HCC presents with acute abdomen, although rare.

Keyword

Carcinoma, hepatocellular; Neoplasm seeding; Rupture, spontaneous

MeSH Terms

Abdomen, Acute
Carcinoma, Hepatocellular*
Emergencies
Hemoperitoneum
Humans
Liver
Magnetic Resonance Imaging*
Mortality
Neoplasm Seeding
Rupture
Rupture, Spontaneous*

Figure

  • Fig. 1 A 40-year-old man with spontaneous rupture of intraperitoneal metastatic mass secondary to HCC. Axial non-enhanced CT scan (a) reveals an irregularly margined 8-cm high-density mass (arrows) in the omentum with hemoperitoneum. On MRI, the mass (arrows) reveals high signal intensity on pre-contrast T1-weighted image (b) and dark signal intensity on T2-weighted image (c). No significantly enhanced portion in the mass (arrows) was noted during dynamic enhancement study (d, arterial phase; e, portal phase; f, 3-min delayed phase). On DWI (b = 800 s/mm2) (g) and ADC map (h), the mass (arrows) does not reveal remarkable diffusion restriction. Follow-up MRI of the patient performed two months later revealed enlarged size, and more well-defined margin of the mass. Highly enhanced portion is well depicted at the periphery of the mass (arrows) on arterial phase image of dynamic enhancement study (i). Gross specimen (j) reveals a 15-cm metastatic HCC that appears to be a well-defined, firm, pink-tan, hemorrhagic mass.


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