PMC5478187_01
Computed tomography of the abdomen. The axial plane (a) as well as the coronal plane (b) in the computed tomography scan of the abdomen showed a hepatic tumor (asterisk) with 6 cm diameter and perihepatic fluid.
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The perforated tumor was actively bleeding into the peritoneal and mesenteric space (Fig. 1).
Transarterial embolization. After puncture of the right femoral artery, a catheter was advanced via the celiac trunc into the common hepatic artery, and the segmental arteries IV and V were selectively embolized with particles (Embosphere 100-300 mum). A highly vascularized tumor without active bleeding is shown in angiography before embolization (a) in segment IV. After tumor embolization, the former hypervascularity of the tumor is absent (b).
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The control showed a successful embolization (Fig. 2).
Residual tumor in magnetic resonance imaging (T2) 1 month after embolization and progression especially in other parts of the liver in computed tomography of the abdomen 7 months after embolization. The axial plane (a) as well as the coronal plane (b) in the T2-weighted magnetic resonance imaging showed a residual tumor in segment IV (arrow) and several new tumors, here one shown in segment III (asterisk). After 7 months, multifocal appearance of the HCC on computed tomography with primary tumor (arrow) and smaller tumors (asterisk) in both lobes was seen on the axial plane (c) as well as the coronal plane (d).
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One month after diagnosis, the liver magnetic resonance imaging (MRI) showed a cirrhotic liver with a tumor of 85 x 72 x 75 mm in segment IV with a necrotic cavity, but no signs of further bleeding or ascites (Fig. 3). Progressive disease with a growing primary tumor, satellite lesions, and an increase of alpha-fetoprotein (47 U/mL) was diagnosed 6 months after TARE (Fig. 3).