李 茂基, 藤田 直孝, 矢野 明, 小林 剛, 長南 明道, 望月 福治

Shigeki LEE, Naotaka FUJITA, Akira YANO, Go KOBAYASHI, Akimichi CHONAN, Fukuji MOCHIZUKI

仙台市医療センター消化器内科

Department of Gastroenterology, Sendai City Medical Center

キーワード : Hyperechoic lesion, Regenerating nodule, Fatty degeneration

A case of hyperechoic regenerating nodules which were very similar to hepatic hemangioma ultrasonographically was reported in detail. A 46-year-old man was referred to our hospital for examination of hepatic tumors. Ultrasonography on admission showed three hyperechoic tumors in the right lobe of the liver. One of them which had "halo", "mosaic pattern" and "posterior echo enhancement" could be diagnosed as hepatocellular carcinoma (HCC) only by ultrasonography. The two other tumors which were different in diameter respectively were homogeneous hyperechoic tumors similar to hemangioma of the liver. CT revealed the larger one as being a well-defined low density area on both the plain and enhanced scans, and it was considered to be a kind of tumor with fatty change. The smaller one could not be detected by CT. Hepatic angiograms showed no remarkable findings except for tumor stain of HCC in cirrhotic liver. Transcatheter arterial embolization therapy (TAE) with Gelfoam particles was performed following hepatic artery infusion with Lipiodol (iodized oil). The ultrasonogram obtained a week after TAE demonstrated air findings in the tumor which was diagnosed as HCC by ultrasonography. No remarkable change was seen in the two other tumors. Follow-up CT identified HCC as areas of markedly high density that indicated selective accumulation of Lipiodol in the tumor. Partial resection of the liver was performed based on the diagnosis of HCC and tumors with fatty infiltration. Histological study confirmed the diagnosis of HCC and two regenerating nodules with severe fatty degeneration.
In conclusion, differential diagnosis of hyperechoic lesion especially in the cirrhotic liver should be made carefully by using not only ultrasonography but also other diagnostic modalities.