Interventional Case 2

CC: Hepatic tumor was told by health exam. 02481718 65y/o, F 65y/o, F CC: Hepatic tumor was told by health exam. 93-7-01 Chest shows no active lung lesion, the heart size is normal but with tortuous aorta. 俞芹英醫師放診專116 (許世芬)

Big Tumor extending to medial segment of Lt lobe. 93-7-22 93-7-22 MR No.13014 Clinical information:Hepatic tumor. Abdominal MRI with and without IV contrast showed: 1.There is a mass, about 11cm in size, over the S4 and S8 level with signal in T1 and high signal in T2. 2.Hypervascular tumor is noted. 3.The spleen, pancreas and both kidneys are normal in size and shape. 4.No paraaortic lymph node or ascites can be seen. 5.The portal vein is preserved. 6.The MR cholangiography shows normal biliary system and pancreatic duct. IMP:Hepatic tumor, hepatocellular carcinoma is suspected. Big Tumor extending to medial segment of Lt lobe.  Suggested PVE before surgery.

93-7-23 12:49:59 Clinical information:Hepatic tumor. Trans- hepatic arterial embolization for hepatoma from Rt transfemoral artery with RC1 Fr.4 showed: 1.There is a hypervascular tumor, about 15cm in size, in the Rt lobe liver which is supplied from the Rt hepatic artery. 2.The tip of the angio- catheter is put on the Rt 3.Lipiodol (20ml) and one pack gelfoam were used. IMP:Rt hepatic tumor with post TAE. 蔡宏名醫師放診專259

93-7-27 09:20:31 Clinical information:Hepatic tumor. Portal vein embolization for hepatic tumor showed: 1.A needle, 18G, is inserted from the abdomen to the Lt portal vein under sonoguide. 2.A catheter, RC1, Fr4, is inserted for portography. 3.There are about 6 packs of gelfoam, 10 coils for embolization. 4.After embolization, the portography showed no visualized of the portal vein supplied in the Rt lobe liver. 5.Post-embolization, the catheter was removed and tract-embolized. IMP:Rt portal vein embolization for hepatic tumor. 蔡宏名醫師放診專259/蔡宏名醫師放診專259 (許世芬)

Liver failure after TAE+PVE 93-7-28 l L-spine films 93-8-3 chest CT 83-8-7 L-spine films 93-8-9 chest film 93-8-12 chest film 93-8-16 chest film 93-8-16 Abd CT CT No:8179 Clinical information:Hepatic tumor. Abdominal CT with and without IV contrast medium showed: 1.There is a mass, about 20cm in size, over the Rt lobe liver with massive tumor necrosis. 2.Prominent lateral segment of the Lt lobe liver is noted. 3.The spleen, pancreas and both kidneys are normal in size and shape. 4.No paraaortic lymph node or ascites can be found. 5.The main portal vein is intact. IMP:Rt hepatic tumor with post TAE. 蔡宏名醫師放診專259

Pathology: Hepatocelluar carcinoma With hepatic vein invasion. Margin: not clear. 93-8-19 Chest film 93-8-23 Chest film 93-8-30 Chest film 93-9-1 Chest film 93-9-6 Chest film 93-9-10 head CT 93-9-11 Head MR 93-9-23 Chest film 93-10-28 Chest film 93-11-20 Chest film

93-9-11 93-9-10 MR No.13607 Clinical history:HCC, unsteady gait. MRI for head with and without contrast medium reveal lesion at the Rt cerebellum which is bright in FLAIR and T2WI with enhancement. A dark signal noted at the Lt pons in FLAIR and gradient echo image. No bright signal in DWI. Tortuous intracranial arteries on MRA. IMP:1.Subacute infarct at the Rt cerebellum. 2.R/O old hemorrhage at the Lt pons(or calcifi- cation). 俞芹英醫師放診專116 (許世芬) CT No:9344 Clinical history:Hepatoma, R/O cerebellar infarct. CT of head without contrast medium shows hypodense region over Rt superior cerebellum. Also noted a small high density area at the Lt pons. IMP:1.Rt cerebellar infarct. 2.Lt pontine calcification or hematoma. 俞芹英醫師放診專116 (許世芬)

追蹤檢查 93-11-23 Abd CT 94-1-7 Abd US 94-3-24 Abd CT 94-4-15 Chest film 94-6-30 Abd CT 94-9-6 Abd CT 94-9-9 Abd US 94-9-13 Abd MR 94-10-28 Abd US 95-1-12 Abd CT 94-9-6 95-1-12