The patient was a 35-year-old woman. A 20 mm single nodule was found in the medial segment of the liver by ultrasonography. All laboratory tests were within the normal limits and all viral markers were negative. Computed tomography revealed a relatively hypodense lesion in segment 3 and 4, which was gradually enhanced. Surrounding area of the lesion was strongly enhanced in arterial phase and isodense in late phase. In magnetic resonance imaging, the lesion was isointense in arterial phase and low intense in hepatocyte phase. Since these radiological findings could not rule out a malignancy and the demarcation of the tumor was unclear, we performed left hepatectomy. The postoperative course was uneventful. Histological findings revealed the final diagnosis of reactive lymphoid hyperplasia. The present patient is the youngest case reported in our country and the radiological findings of the tumor were different from the past reported cases.

We report a rare case of hepatic sarcoidosis complicated by portal hypertension. A 39-year-old male patient underwent laparoscopy, which was useful for accurate diagnosis. The initial symptom was hematemesis caused by rupture of esophageal varices 2 years ago. At that time, the chest CT scan showed bilateral hilar lymphadenopathy and small granular shadows in the both lung fields. Lymph node biopsy demonstrated noncaseating granuloma. Based on these findings, he was given a diagnosis of pulmonary sarcoidosis. Since no respiratory disturbance was observed, he was referred to our department for further investigation of portal hypertension. Liver surface images obtained by a laparoscopy showed many white nodules. Liver biopsy revealed noncaseating granuloma in portal areas. Thus, we speculated nodules of sarcoidosis caused portal hypertension. Because hepatic sarcoidosis progressed to liver cirrhosis,we administrated corticosteroid to reduce deisease activity. Currently, liver function tests have improved slightly and esophageal varices remained stable.

A case of amebic liver abscess complicated by hepatic vein thrombus and pulmonary embolism: A-65-year-old man presented with persistent fever and diarrhea since onset three days previous, and he was admitted to our hospital in July, 2016. Upon admission, a computer tomography scan (CT) revealed a liver abscess, which measured 49 mm in size, appearing in segment 8 and which was complicated by hepatic vein thrombosis with pulmonary embolism. Immediately, he was administered biapenem; in addition, danaparoid sodium was used for disseminated intravascular coagulation and portal vein thrombosis on day 3. On day 5, we opted to perform ultrasound-guided catheter drainage for the abscess, however, his condition was did not improve. On day 6, we administered metronidazole because of our suspicion of an amebic liver abscess. Thereafter, we diagnosed him with amebic liver abscess due to positive amoebic antibodies. After the treatment, his condition improved. On day 25, a follow-up CT revealed the liver abscess and hepatic vein thrombosis were remained but no obvious pulmonary embolism was found. In conclusion, a pulmonary embolism should be taken into consideration in cases of amebic liver abscess complicated by hepatic vein thrombosis.

Transcatheter arterial chemoembolization (TACE) is the most commonly performed treatment for hepatocellular carcinoma (HCC). Because most patients with HCC have liver cirrhosis, ascites or pleural effusion occasionally occurs after TACE.

Tolvaptan (TLV) is a selective V2 receptor antagonist. It acts in the distal uriniferous tubule to increase excretion of free water. TLV has the advantage of causing less renal dysfunction and hyponatremia. Therefore, we administrated TLV directly after TACE to HCC patients with liver cirrhosis who have a history of ascites or pleural effusion after TACE. It was effective in increasing postoperative urine volume, preventing edema, and maintaining renal function.

It is important to protect renal function during treatment for HCC. TLV might be a useful drug for preventing edema during post-TACE hydration.

We evaluated clinical utility of the fibrosis index based on the four factors (FIB-4) and the aspartate aminotransferase to platelet ratio index (APRI) for screening of chronic liver disease (CLD) and liver cirrhosis (LC). Diagnoses were extracted from the electronic medical records. Among 1194 patients except of acute illness, 318 had CLD and 48 had LC. The areas under the receiver operating characteristic curves of FIB-4 and APRI for predicting LC were 0.913 and 0.897, respectively, while those for predicting CLD were 0.630 and 0.672, respectively. With FIB-4 3.25 and APRI 1.0 for the cut off values to predict LC, the diagnostic accuracies were 91.5%, 94.2%, respectively. FIB-4 and APRI were considered useful for screening of CLD with advanced fibrosis.