Clinics in diagnostic imaging (116). Ruptured hepatocellular carcinoma.

A 37-year-old Chinese man with chronic hepatitis B, who frequently defaulted past follow-up appointments, was admitted for acute abdomen and shock. Computed tomography of the abdomen revealed a ruptured hepatocellular carcinoma involving the left lobe. After fluid resuscitation, gelfoam embolisation was performed to arrest the bleeding, followed by segmental resection of the hepatic lesion. There was aggressive recurrence following left segmental hepatectomy, and despite two courses of transarterial chemoembolisation, the patient died of local and pulmonary recurrences five months after his initial presentation. The management of hepatocellular carcinoma rupture is discussed.

Clinics in diagnostic imaging (115). Extraluminal biliary tree obstruction due to compression by pancreatic head tumour.

A 58-year-old Chinese woman presented initially with obstructive jaundice. Initial ultrasonography showed gallstones, calculus in common bile duct, and obstructed biliary system. Endoscopic retrograde cholangiopancreatography showed an extrinsic compression at common bile duct, and subsequent computed tomography scan showed a mass in the head of the pancreas. Endoscopical ultrasonography revealed masses in the gallbladder and pancreas. An exploratory laparotomy confirmed gallbladder cancer with spread to pancreas, segment IV of the liver, and regional lymph nodes. The patient was treated palliatively with metallic biliary stent for biliary drainage.