平田 真美¹, 西村 庸夫¹, 兵藤 真¹, 平田 康隆¹, 井内 英人², 大久保 啓二²

Mami HIRATA¹, Nobuo NISHIMURA¹, Shin HYODO¹, Yasutaka HIRATA¹, Hideto IUCHI², Keiji OKUBO²

¹松山城東病院, ²愛媛大学第3内科

¹Matsuyama Jyoto Hospital, ²Thrd Department of Internal Medicine, Ehime University School of Medicine

キーワード : Alcoholic liver cirrhosis, Color Doppler ultrasonography Regenerative nodule

Nodular lesions consisting of hyperplasia in liver cirrhosis are classified roughly into adenomatous hyperplasia and regenerating nodules. Adenomatous hyperplasia is recognized as a precancerous change toward hepatocellular carcinoma, while the canceraous process is discarded in regenerating nodules. Here we report a case of alcoholic cirrhosis in which the imaged protruding portion of the caudate lobe had the appearance of a node, and which was histologically diagnosed as a macro-regenerating nodule. The various diagnostic imaging techniques that we used in the attempt to differentiate this lesion from adenomatous hyperplasia and hepatocellular carcinoma showed a greater abundance of blood vessels from the hepatic artery and portal vein in the node than in the surrounding liver parenchyma. The blood-flow pattern differed from that of adenomatous hyperplasia or hepatocellular carcinoma, and dilatation of existing blood vessels was the most evident imaged finding. While the margin of the liver was established histologically as cirrhosis, regeneration appeared to be accelerated in the nodes. These histologic findings led us to suspect that the macro-regenerating nodule was caused by imbalance in local blood distribution. Plain ultrasonic imaging was sufficient to distinguish between the histologic structure of the margin of the liver and that of the nodes, while color Doppler ultrasonic imaging could more objectively assess differences in blood distribution.