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The findings of ruptured hepatocellular carcinoma on helical CT

B G Choi, MD 1 S H Park, MD 1 J Y Byun, MD 1 S E Jung, MD 1 K H Choi, MD 1 and J-Y Han, MD 2

1 Departments of Radiology 2 Internal Medicine, College of Medicine, The Catholic University of Korea, Korea



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  		Figure 1. 64-year-old man with ruptured hepatocellular carcinoma (HCC) during follow-up study. (a) Arterial phase CT shows a well enhancing mass with protruding contour in the right hepatic dome (arrows). Marked ascites present. (b) After 28 days, the tumour contents have ruptured beyond the hepatic surface, with subtle rim enhancement (enucleation sign). Marginal discontinuity is noted (arrows). Newly developed low attenuating lesions are noted on the posterior aspect of the ruptured HCC.

 


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  		Figure 2. 69-year-old man with ruptured hepatocellular carcinoma (HCC) during follow-up study. (a) Delayed phase CT shows a large mass with protruding contour in the right hepatic dome. Marginal disruption is suspected (arrows). Definite signs of HCC rupture were not found on physical examination. (b) 6 days later, CT was repeated because of abdominal distention with abdominal pain. Tumour rupture into the intraperitoneal space is seen on portal phase CT. Markedly decreased attenuation is noted within the lesion.

 


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  		Figure 3. 56-year-old man with ruptured hepatocellular carcinoma on initial study. (a) Arterial phase CT shows densely enhancing peripheral rim (arrowheads) and mildly enhancing tumour in the hepatic angle. The tumour is separated with rim enhancement by the fluid density. Marginal break is noted (arrows). (b) On delayed phase at the same level, tumour enhancement has subtly reduced. The enhancing rim has become slightly hyperdense relative to liver parenchyma (arrowheads).

 


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  		Figure 4. 55-year-old man with ruptured hepatocellular carcinoma during follow-up study. (a) Portal phase CT shows multiple ill defined, low attenuating lesions with solid components in the right and caudate lobe. A nodular high density in the caudate lobe (arrow) represents lipiodol uptake by the lesion during previous transarterial injection. (b) After 17 days, almost all the lesions have become non-enhancing low attenuating, and further low attenuating nodular lesions are now detected (arrows). The non-enhancing low attenuating lesions are larger in area and have more distinct margins than the initial detected lesions (arrowheads). A ruptured mass is not suspected.

 




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