2022 Volume 64 Issue 12 Pages 2503-2508
A 57-year-old Japanese male with chronic hepatitis B and alcoholic liver disease underwent radiofrequency ablation for S3 and S7 hepatocellular carcinoma (HCC) one and a half year ago. Follow-up gadolinium-ethoxybenzyl-diethylenetriaminepentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (EOB-MRI) showed a growing 2-cm hepatic tumor in the lateral segment S2, without arterial phase enhancement but with low-intensity portal phase images. As typical findings of HCC, such as hypervascularity, were not found on MRI, contrast-enhanced (CE) ultrasonography was planned. However, performing extracorporeal ultrasonography was difficult because of left lung interference; therefore, EUS was employed. The tumor showed slightly hypoechoic, and CE-EUS using perflubutane showed early arterial phase enhancement and delayed phase washout. Thus, HCC was diagnosed. As the patient chose minimally invasive treatment for the HCC, EUS-guided ethanol injection was performed as ablation therapy. Treatment was successful and without complications, and no local recurrence was observed after 1 year and 8 months. EUS is useful in diagnosing and treating HCC when extracorporeal US is difficult to perform, such as in the lateral segment where lung air interferes with imaging.
