医学影像学(6.5.3)--肝癌CT病例讨论
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CT 动脉期增强 (Contrast enha nced CT, arteri
al phase)
CT 静脉期增强 (Contrast enha nced CT, veno
us phase)
CT 延迟期增强 ,(CECT, delaye
d phase)
CT 所见
肝脏体积较小，边缘轻度波浪状，肝内密度不均匀，呈弥漫 小结节状，肝右前上叶（ VIII 段）见团块状占位性病变，大 小约为 7.4×5.3cm ，边界欠清楚，形状不规则，平扫呈略低 密度，密度不均匀；动态增强扫描动脉期病灶不均匀强化， 门脉期强化程度下降，延迟扫描病灶呈低密度，门静脉右支 显示不清，肝内胆管无扩张。脾大，约 10 个肋单元，肝周 及脾周可见弧形液性密度影，胆囊不大，囊壁较厚，胰腺无 异常，食管周围、脾门及胃底可见多条迂曲的血管影。腹膜 后未见肿大淋巴结。
History: Having had a history of chronic hepatitis for 26 yrs. An intraheultrasound examination 4 months ago
Symptoms and Signs: Mildly yellowish skin and sclerae, no ‘hepatic palms’ a nd spider-like nevuses. Distended abdomen without venous varices on abdomi nal wall. Inferior edge of liver was palpated 3 cm below right inferior costal ridg e, and blunt. Hard hepatic texture and undulating surface were shown. No pain felt on palpation or percussion. Spleen was not palpated at left upper abdomin al quadrant. Shifting dullness doubted
English case discussion
Case 1-CT208686
主诉：男， 56 岁，因检查发现肝占位 4 月入院 病史：已肝病史 26 年， 4 月前 B 超检查发现肝
占位性病变。
症状体症：皮肤、巩膜轻度黄染，无肝掌及蜘 蛛痣。腹部饱满，无腹壁静脉曲张，于右肋缘 下 3cm 触及肝脏，边钝，质硬，表面不平，无 触痛，无叩击痛。脾肋缘下未触及，移动性浊 音 (±) 。
Laboratory Findings: a-FP(a-Feto-protein) 1000 ng/ml, Australian antibody t est: superficial antigen and c-antibody showed positive
CT 平扫 (Plain CT)
CT Findings
Liver showed smaller than normal in size, with undulated rims and heterogene ous parenchymal density looked like diffused mini-nodules. In the antero-super ior segment of right hepatic lobe (SVIII), an irregular shaped mass with unclear contour, measured approximately 7.4x5.3 cm was seen.
On plain CT, the mass showed irregularly hypodense. On dynamic enhanced s cans, the mass enhanced heterogeneously in arterial phase and the enhance ment faded in a certain extent in portal vein phase, while in delayed phase hyp odense lesion was shown. Right main branch of portal vein was not clearly not ed. No dilatation of intrahepatic biliary ducts were seen. Splenomegaly, measu red approximately 10 rib-units. At periphery of liver, liquid density shadows of c rescent shape were demonstrated. Gall bladder was normal in size, whereas, wall thickened. Pancreas was normal. Multiple tortuous vessels were seen in p eri-esophagus space, splenic hilum and gastric fundus. No enlarged lymph no des were found in retroperitoneal space
化验： AFP1000ng/ml ；乙肝两对半：表面抗原 及 c 抗体阳性。
Clinical Materials
Chief Complaints: The patient, male, 56 yrs of age, was hospitalized because an intrahepatic mass has been found for 4 months
