CT Findings of Small Bowel Metastases From Primary Lung Cancer

PURPOSE: To evaluate the CT findings of small bowel metastases from primary lung cancer. MATERIALS AND METHODS: Of the 1468 patients with primary lung cancer between 1990 and 2000, 13 patients who had metastasis to the small intestine were collected. Of these 13 patients, nine who underwent CT scan were included for analysis. The pathologic diagnoses of primary lung cancer in these nine patients were squamous cell carcinoma in six, adenocarcinoma in two, and large cell carcinoma in one. CT scans were analyzed with regard to the site and patterns (intraluminal mass/bowel wall thickening/bowel implants) of metastatic masses, and the presence or absence of complication such as intussusception, obstruction, or perforation of the small bowel. The medical records of the patients were also reviewed retrospectively for evaluation of presenting abdominal symptom and time interval of metastases from initial diagnosis of lung cancer. RESULTS: Metastatic lesions were distributed throughout the small intestine: the duodenum in five, the jejunum in four, the ileum in six, and both jejunum and ileum in one patient. The size of metastatic masses of small bowel ranged from 1.3 cm to 5.0 cm (mean size, 2.6 cm) On CT, the small bowel was involved with intraluminal masses (mean size, 3.4 cm) in eight patients, diffuse wall thickening (mean thickness, 1.6 cm) in five, and bowel implants (mean size, 2.2 cm) in two. Complications occurred in seven patients, including intussusceptions without obstruction in two patients and with obstruction in two, obstruction without intussusceptions in two, and bowel perforation in one. Of 9 patients, 6 had at least one symptom referable to the small bowel including abdominal pain in 4, anemia in 3, vomiting in 1, and jaundice in 1. Lung cancer and small bowel lesions were detected simultaneously in four patients and the time interval of metastases from initial diagnosis of lung cancer ranged from 10 days to 30 months (median interval, 54 days) in 5 patients. CONCLUSION: CT helps in defining the extent and pattern of small bowel metastases as well as in demonstrating their complication.

Well-Differentiated Hepatocellular Carcinoma: Triple-Phase Helical CT Findings

PURPOSE: To determine the imaging characteristics of well-differentiated hepatocellular carcinomas (HCCs), as seen at triple-phase helical CT. MATERIALS AND METHODS: Thirty-eight well-differentiated HCCs in 29 patients who underwent surgical resection comprised our study population. Triple-phase helical CT images were obtained at 30 seconds, 70 seconds, and 3 minutes after contrast injection, and HCCs were divided into four groups according to their size: smaller than 1 cm (n=12), 1-2 cm (n=15), 2-4 cm (n=8), and larger than 4 cm (n=3), The enhancement patterns of HCCs at triple-phase helical CT were retrospectively analysed. RESULTS: In the smaller than l cm group, the most common enhancement pattern at all three phases was iso-attenuation (n=8; 67%). In the 1-2 cm group, iso-attenuation (n=10; 67%) was most common during the arterial phase and slightly low attenuation during the portal and equilibrium phases while in the 2-4 cm group, high attenuation (n=6; 75%) was most common during the arterial and portal phases, and low attenuation during the equilibrium phase (n=6; 75%). Two (67%) of three cases in the larger than 4 cm group demonstrated low, including fatty, attenuation. The detection rate was 33% (4/12) in the smaller than 1 cm group, 87% (13/15) in the 1-2 cm group and 100% (11/11) in the 2-4 cm and larger than 4 cm groups. CONCLUSION: At triple-phase helical CT, the enhancement patterns of well-differentiated HCCs were diverse, and the detection rate of those larger than 1 cm was 92% (24/26).

Postoperative Intraabdominal Fluid Collections: A Modified Percutaneous Drainage Method using a Surgical Drain Track

In the management of postoperative fluid collection, the conventional percutaneous drainage method can be employed. Because of abdominal incisions and various types of surgical drains and/or T-tubes, the application of this method is not always easy, however. We inserted a drainage catheter through a pre-existing percutaneous track formed by a surgical drain located adjacent to the site of abnormal fluid collection. There was no need to remove the drain nor make an additional puncture in the abdominal wall. A dilator was inserted along the drain, and a guide wire was used to negotiate its intraperitoneal track and readch the accumulated fluid. The procedure was simple and safe. We briefly deseribe our experience of this modified percutaneous drainage technique, as used in three cases involving postoperative fluid collection.

Embolization of Seve re Arterioportal Shunts in the Patients with Hepatocellular Carcinoma: Safety and Influence on Patient Survival

PURPOSE: To evaluate the safety and the influence of embolization of severe arterioportal shunts, and the effect of the procedure on the survival rate of patients with hepatocellular carcinoma combined with portal vein tumor thrombosis. MATERIALS AND METHODS: This study involved a total of 54 patients with hepatocellular carcinoma in whom hepatic arteriography revealed severe arterioportal shunt. From among this total, 34 patients (embolization group) underwent chemoinfusion after shunt embolization, while 19 (control group) underwent chemoinfusion only. The embolic materials included PVA particles and/or Gelfoam pieces. The frequency of postembolization symptoms (Chi-squared test) and changes in laboratory values (paired t-test) were compared between the two groups, and shunt improvement was also evaluated. Patient survival was tested using the Kaplan-Meier method. RESULTS: Fever and RUQ pain were more frequent in the embolization group (p<0.001). The complications of embolization included severe postembolization syndrome (n=1), acute hepatic failure (n=2), hepatic infarction (n=1), and sepsis (n=1). There were no significant changes in laboratory values. Among the 28 patients (24 of embolization group and four of control group) who underwent follow-up angiography, arterioportal shunt became less severe or disappeared in ten of the embolization group. For the embolization and control groups, the mean survival interval was 29.5 +/-5.4 weeks and 10.3 +/-3.1 weeks (p=0.0002), respectively. The best results were seen in the PVA particle group (p=0.01). CONCLUSION: The embolization of severe arterioportal shunts is relatively safe and increases patient survival rate.

Hepatocellular Carcinoma with Extensive Hepatic Artery Injury: Transcatheter Arterial Chemoembolization through Collaterals after Coil Embolization of Gastric Arteries

PURPOSE: To evaluate the efficacy and safety of transcatheter arterial chemoembolization(TACE) after coil embolization of the gastroduodenal artery in hepatocellular carcinoma cases with multiple collateral arteries caused by proper hepatic artery injury. MATERIALS AND METHODS: Between March 1997 and November 1998, a prospective trial of transcatheter arterial chemoembolization (TACE) was performed through collaterals from the gastroduodenal artery of 31 hepato-cellular carcinoma patients with extensive proper hepatic artery injury due to repeated TACE. Among this number, 16 (group A) underwent TACE after coil embolization of the right gastric and gastroduodenal artery. The other 15 patients (group B) underwent TACE without coil embolization. The two groups had the same T-NM stage and Child-Pugh status. During the follow-up period, group A underwent additional TACE 3.3 times, and group B 2.8 times. The therapeutic effect of TACE was evaluated with computed tomography and by measuring alpha-fetoprotein levels. Complications were evaluated by means of gastrofibroscopy, laboratory data, and evalvation of the patients clinical symptoms. The results obtained after six months and one year were compared within and between each group. RESULTS: At six months follow-up, CT findings had improved or were unchanged in 11 patients(69 %) in group A, and four patients(27 %) in group B(p=0.032). In ten patients in each group, the level of alpha-fetoprotein was above 200 ng/ml. Its level was decreased in five patients(50%) and three patients(30%), respectively. The six-month survival rate was 81 %(13/16) in group A and 67 %(10/15) in group B (p=0.43), while the one-year survival figures for these two groups were 50 %(8/16) and 20%(3/15), respectively(p=0.135). In group A, the CT findings were steady in five out of eight patients(63%), while in group B, CT findings showed that tumors with increased alpha-fetoprotein levels had increased in size and/or number. In group A, it was found that in two (33 %) of six patients whose initial alpha-fetoprotein level was over 200ng/nl, this level had decreased. Acute gastric ulcer was found in two patients in group A, and mild acute pancreatitis in one. One patient in group B was also found to have an acute gastric ulcer. CONCLUSION: In view of the advanced disease stage of patients for whom a long period has elapsed since initial diagnosis, TACE after coil embolization of gastric arteries may be a safe and acceptable method for use in the treatment of hepatocellular carcinoma with extensive hepatic artery injury.