原发性肝癌自发性破裂出血临床特点及影像学诊断

Diagnosis of Acute Hemoperitoneum due to Spontaneous Rupture of Hepatocellular Carcinoma: The Clinical and Imaging Characteristics

目的 探讨原发性肝癌 (HCC)自发性破裂出血的临床特点及影像学表现。材料与方法 根据 9例HCC自发性破裂继发腹腔内出血临床表现 ,结合超声、CT、血管造影征象进行分析。结果 HCC自发性破裂出血临床主要表现为急性上腹部疼痛、腹腔内出血、失血性休克。超声检查主要显示HCC出血部位出现高回声区。CT扫描显示HCC出血区出现高密度影 ,腹腔内出血表现为腹腔积液CT值增高。血管造影显示肿瘤血管破裂区出现对比剂外溢。结论 影像诊断敏感性CT高于超声 ,血管造影最低。HCC自发性破裂继发腹腔内出血是威胁患者生命的临床急症之一 ,早期正确诊断是治疗的基础。

Objective To investigate the clinical and imaging characteristics of acute hemoperitoneum due to spontaneous rupture of hepatocellular carcinoma (HCC).Materials and Methods The clinical manifestations, and the radiographic as well as ultrasonic features in 9 patients with hemoperitoneum associated with spontaneous rupture of HCC were analyzed.Results The main clinical manifestations were acute abdominal pain, hemoperitoneum and hypovolemic shock. Sonogram revealed high echo area at the bleeding site. Plain CT scans showed high density blood within the low attenuation tumor area. Hemoperitoneum was characterized by ascites with an increased CT value. On angiography, contrast extravasation was seen (n=1).Conclusion Spontaneous rupture of HCC is a life threatening condition, early diagnosis is urgent in order to save life. For its diagnosis, CT is more sensitive than sonography, while the angiography is the least sensitive.