PMC10294023_01
Primary tumor. CT scan. Right colon neoplasia of 5 cm extension (red star), multiple liver tumors. Largest liver tumor of 13 cm in its major axis (yellow arrow).
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IV contrast (Fig. 1). It also showed bilateral lower lobe lung nodules no larger than 5 mm, both liver and lung findings, highly suggestive of metastatic disease.
Liver volumetry. CT scan. Total liver volume = 1,152.68 cm2. Right liver volume = 757.73 cm2. FLR = 398.95 cm2 (34.6%).
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Liver volumetry was performed by this moment, finding a future liver remnant (FLR) with a total volume of 394.9 cm3 out of 1,152.68 cm3, even though this volume might be accepted as a good FLR, we decided to perform portal vein embolization (PVE) because of the surgery extension and the chemotherapy regimen (Fig. 2).
Liver tumors in PET-CT. a, c Axial and coronal plane with hyperglycolytic metabolism with hepatic findings in VIII, VII, V, and VI segments. b, d CT scan: Axial and coronal plane with liver tumors with diameter ranging from 13 to 5.8 cm, compatible with metastatic disease.
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A PET-CT reported hyperglycolytic metabolism in lung nodules and hepatic findings in VIII, VII, V, and VI segments, compatibles with metastatic disease (Fig. 3).
Portal vein embolization. a Transport system of embolization material. Microcatheter (HISTOACRYL EMBOLIZATION). Catheter 0.035 (EMBOLIZACION SYSTEM WITH COILS). b Right portal vein (arrow) embolization with LIPIODOL+HISTOACRYL. c Right PVE with LIPIODOL + HISTOACRYL + COIL in right hepatic vein (arrow). Digital subtracted image.
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After the imaging tests, the patient underwent a liver biopsy + portography + right portal embolization + right hepatic vein venography + right suprahepatic embolization (Fig. 4).
Post-portal vein embolization volumetry. CT scan. FLR = 406.30 cm2.
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After the PVE, a new CT scan was made so new volumetry could be done, showing response to the treatment increasing 11.35 cm3 (34.6% of FLR) (Fig. 5).
Major right hepatectomy. a Macroscopic view of the resected right hepatic lobe. b Liver remnant in the abdominal cavity.
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The macroscopic view of the liver removed lobe showed evident metastases in the VIII and VII segments (Fig. 6), as well as posterior area of embolization.
Post-right hepatectomy. CT scan. a 3D reconstruction of liver remnant. b Volumetry of liver remnant = 576.92 cm2.
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One month later, the patient underwent a control CT for liver size evaluation, with a 30% growth of the remaining liver (Fig. 7).