Abstract
A 57-year-old man was admitted to our hospital for advancec gallbladder cancer. A tumor has invaded the liver deeply from the left medial segment to the right lobe. It also invaded the hepatic hilum, so percutaneous transhepatic bile duct drainage was perfomed. Abdominal angiography revealed encasement at the first-ordered branch of the right hepatic artery. Percutaneous transhepatic portography showed slight compression of the portal venous trunk below the bifurcation. In order to prepare for massive resection of the liver, percutaneous transhepatic embolization of the right portal venous branch was done. At operation, intraportal ultrasonography (IPUS) revealed destruction of the echogenic band of the portal venous wall, and a diagnosis of portal venous invasion of the tumor was made. Based on this IPUS finding, extened right hepatic lobectomy with combined resection of the portal vein was performed. Histological examination confirmed the portal venous invasion. Its ability to distinguish between portal vein compression and invasion makes IPUS an effective aid in formulating operative strategy.
