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Two patterns of contrast-enhanced ultrasonography with Sonazoid® in spontaneous rupture of hepatocellular carcinoma: a report of four cases

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Abstract

Spontaneous rupture is a life-threatening complication of hepatocellular carcinoma (HCC). Detecting active bleeding is critical. Color Doppler and contrast-enhanced ultrasonography (CEUS) with Levovist® are reported to be useful for detecting active bleeding. A few reports have described using Sonazoid® to detect bleeding in ruptured HCC. This report describes two distinctive patterns of bleeding from ruptured HCC observed in CEUS with Sonazoid®. Four patients with suspected HCC rupture were examined by gray-scale ultrasonography (US) and then CEUS with Sonazoid®. Two patterns of bleeding were observed with CEUS: jet-like extravasation (n = 2) and bubble leakage (n = 2). While contrast-enhanced computed tomography and angiography revealed active bleeding in only one patient, CEUS detected active bleeding and enabled the bleeding site to be estimated in all patients. Transcatheter arterial embolization was performed based on the findings of CEUS, and hemostasis was achieved in all patients. CEUS using Sonazoid® could demonstrate active bleeding as two patterns, and these findings enabled us to detect the rupture site of HCC more confidently than with other modalities.

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Authors and Affiliations

  1. Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, 683-8504, Japan

    Takaaki Sugihara, Masahiko Koda, Toshiaki Okamoto, Kenichi Miyoshi, Tomomitsu Matono & Hajime Isomoto

Authors
  1. Takaaki Sugihara
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  2. Masahiko Koda
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  3. Toshiaki Okamoto
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  4. Kenichi Miyoshi
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  5. Tomomitsu Matono
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  6. Hajime Isomoto
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Corresponding author

Correspondence to Takaaki Sugihara.

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The authors declare that they have no conflict of interest.

Human rights statements and informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. Informed consent was obtained from all patients for being included in the report.

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Sugihara, T., Koda, M., Okamoto, T. et al. Two patterns of contrast-enhanced ultrasonography with Sonazoid® in spontaneous rupture of hepatocellular carcinoma: a report of four cases. J Med Ultrasonics 45, 319–323 (2018). https://doi.org/10.1007/s10396-017-0812-7

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  • DOI: https://doi.org/10.1007/s10396-017-0812-7

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