2023 Volume 64 Issue 11 Pages 567-574
The patient was a man in his 30s. During childhood, he underwent Fontan surgery for complete transposition of the great arteries type III. On July 20XX, he was referred to our hospital because of multiple hepatic masses detected by abdominal ultrasonography. Contrast-enhanced computed tomography revealed multiple hepatocellular carcinoma of up to 13 cm (Barcelona Clinic Liver Cancer Stage B). Despite the absence of signs of portal hypertension such as splenomegaly and no liver morphological abnormalities were obvious on imaging, a liver biopsy revealed a congestive hepatic fibrosis score of 3, indicating the progression of fibrosis. Surgery and RFA were not indicated because of intrahepatic multiple lesions. Furthermore, since the largest tumor protruded outside the liver and he was at risk of intra-abdominal rupture, transarterial chemoembolization was performed first. Thereafter, various anticancer drug treatments were performed according to recurrence, and the patient survived. Although the images did not suggest liver fibrosis, the special hemodynamics after Fontan surgery may have induced the progression of liver fibrosis; thus, this case emphasizes the importance of liver cancer surveillance.
