Kentaro Yoshioka

Contrast-enhanced US with Sonazoid showed the same sites enhanced in the vascular phase, and showed contrast defect in the postvascular phase. Plain CT showed low density tumors with unclear boundary. In dynamic CT, arterial phase showed the tumors enhanced faintly, and portal-venous phase showed low density tumors compared with surrounding liver. Gd-EOB-MRI showed multiple tumors which were enhanced in arterial phase, and showed low intensity in hepatocyte phase. Portal vein was observed in the S3 tumor. PET-CT showed multiple abnormal accumulation in the liver, mediastinal lymph node, and hilar lymph node. We underwent a liver tumor biopsy because the tumors were atypical as HCC, and showed an elevation of IL-2R. Biopsy histology showed the finding of MALT lymphoma. Thus we underwent chemotherapy. This case is a valuable case because multiple lesions of hepatic MALT lymphoma with type C cirrhosis is rare, and chemotherapy has become possible after diagnosis by tumor biopsy. © 2014 The Japan Society of Hepatology.

A 76-year-old man was admitted due to fever and general fatigue. He had undergone three sessions of repeated transcatheter arterial chemoembolization (TACE) with arterial infusion therapy using cisplatin for multiple hepatocellular carcinoma at our hospital. An abdominal CT scan showed a low density area surrounding the spleen. Since US guided drainage revealed that the low density area was filled with bile juice, we performed endoscopic retrograde cholangiopancreatography (ERCP), which showed choledocholithiasis and the leakage of contrast medium from the peripheral intrahepatic bile duct to the extrahepatic area surrounding the spleen. Thus a diagnosis of an extrahepatic biloma surrounding the spleen was made, and an endoscopic biliary drainage (EBD) tube was placed. The biloma rapidly decreased. When endoscopic sphincterotomy (EST) and removal of the bile duct stone were performed after two weeks, ERCP showed no leakage of bile juice to the extrahepatic area. ERCP and EBD were useful for the diagnosis and treatment of an extrahepatic biloma surrounding the spleen.

Case is a 29-yr-old man, whose complaint was abdominal pain He had photosensitivity since childhood The paternal grandfather and the younger brother have photosensitivity. In November 2001, he admitted in the other hospital with liver dysfunction and was diagnosed as erythropoietic protoporphyria (EPP). In August 2005, he admitted with abdominal pain and jaundice and recovered with antibiotics In January 2006, he was referred to our hospital with mild elevation of ALT. In November 2006 and in May 2007, he admitted in our hospital with abdominal pain and jaundice, and recovered with antibiotics In August 2008, he admitted with the same symptoms. Erythrocyte protoporphyrin and total bilirubin continually elevated. He died from liver failure in November 2008. A small portion of EPP patients suffer from liver failure. The only effective treatment for liver failure of EPP is liver transplantation, which should be considered at appropriate timing of the disease course. © 2010 The Japan Society of Hepatology.

A 32-year-old man consulted a local hospital for epigastric pain and was diagnosed as obstructive jaundice. He was referred and hospitalized in our hospital. One year ago, he had treatment of pulmonary tuberculosis. Contrast-enhanced abdominal multi-detector row CT (MD-CT) showed a low density mass with an enhanced rim at hepatic portal region. PTBD was done and revealed a smooth narrowing of the upper part of common biliary duct. Based on these results, we suspected that an enlarged lymph node at hepatic portal region caused obstructive jaundice. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of the lymph node at hepatic portal region was done. The pathology of specimen showed caseating granulomas and polymerase chain reaction analysis for tuberculosis of the specimen was positive. Thus we diagnosed as tuberculous lymphadenitis at hepatic portal region which caused obstructive jaundice. Antituberculosis medications were started and the size of the lymph node reduced gradually. After 6 months, biliary drainage tube was removed, and the patient stayed well without development of jaundice.

We describe the basics, devices and utility of three-dimensionaltransabdominal ultrasonography (3DUS). 3DUS volume measurements are accurate regardless of gallbladder configuration. 3DUS may be the most reliable method to estimate gallbladder motility. Virtual endoscopy imaging using 3DUS made it easier to understand three-dimensional shapes and surface conditions of the lesions, and it was more objective and stringent than conventional ultrasonography. We expect that 3DUS will contribute to the advance of ultrasonographic diagnoses of bilio-pancreatic diseases. © 2006, The Japan Society of Ultrasonics in Medicine. All rights reserved.