PMC5410483_01
Computed tomography images at the time of diagnosis. A huge mass was noted in the left upper lobe, expanding to the left hilum and mediastinum (A). Multiple liver tumors were located in the left and right lobes of the liver (B).
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A computed tomography (CT) scan revealed a huge mass in the left upper lobe (maximum size: 11.0 cm in diameter) that subsequently expanded to the left hilum and mediastinum, as well as an intrapulmonary metastasis located in the left lower lobe, pleural effusion on the left side, and multiple liver tumors ranging from 0.5 to 4.7 cm in diameter (Fig. 1).
Computed tomography images on Day 3 after initiating chemotherapy. The plain scan revealed an enlarged hepatic tumor in the left lobe containing a high-density area and ascites showing relatively high density (A). A contrast-enhanced scan was negative for extravasation (B).
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We attempted to identify the bleeding site on gastrointestinal endoscopy, to no avail, but a CT scan revealed the rapid enlargement of a liver tumor in the left lobe, which contained partial high-density areas on the plain scan, and also a novel finding of ascites showing higher density than usual, all suggesting a ruptured liver metastasis and associated hemorrhagic ascites (Fig. 2).
Angiography of the left hepatic artery before (A) and after (B) transcatheter arterial embolization. No obvious tumor stains or extravasation was observed in the left hepatic lobe (A). After embolization, the blood flow was slowed, and the peripheral vessels were visualized weakly (B).
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He underwent angiography for the left and right hepatic arteries, but we only observed obscure tumor vessels in the left hepatic lobe without extravasation (Fig. 3A). Post-embolization angiography revealed a slowed blood flow in the left hepatic artery, and the peripheral vessels were weakly visualized (Fig. 3B).