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Weekly Chest CasesArchive of Old Cases

Case No : 457 Date 2006-07-31

  • Courtesy of Seong Hoon Park, MD, Eun Jin Chae, MD, Kyung-Hyun Do, MD. / Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  • Age/Sex 45 / M
  • Chief ComplaintAbnormal finding on liver dynamic CT
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Metastasis of Hepatocellular Carcinoma to Inferior Vena Cava through Inferior Phrenic Vein
Radiologic Findings
Mediastinal windows of enhanced chest CT show low attenuated filling defect in the IVC, inferior phrenic vein and right atrium. Liver dynamic CT show lower attenuated mass with enhancement in the right anterior segment of liver. Surgical en-block resection of tumor thrombi in the IVC and right atrium was performed.
Brief Review
The incidence of portal vein and/or inferior vena cava tumor thrombi is higher in patients with hepatocellular carcinoma (HCC). It has been reported in as many as 44?84% of these patients in autopsy data. It has also been estimated, from clinical data, that the incidence of HCC thrombosis ranges between 34% and 50%. Most of these patients have a poorer prognosis; their duration of survival is only 2.4?2.7 months without treatment. The inferior phrenic vein (IPV) is one of the major sources of collateral venous drainage in HCC. Additional venous drainage provided by the IPVs could serve as a possible route of metastasis through the diaphragm and into the thoracic cavity. This case show IVC and right atrium metastasis through right inferior phrenic vein.
References
1. Zeng ZC, Fan J, Tang ZY, Zhou J, Qin LX, Wang JH, Sun HC, Wang BL, Zhang JY, Jiang GL, Wang YQ. A comparison of treatment combinations with and without radiotherapy for hepatocellular carcinoma with portal vein and/or inferior vena cava tumor thrombus. Int J Radiat Oncol Biol Phys. 2005;61:432-443.

2. Loukas M, Louis RG Jr, Hullett J, Loiacano M, Skidd P, Wagner T. An anatomical classification of the variations of the inferior phrenic vein. Surg Radiol Anat 2005; 27: 566-574
Keywords
Vascular, Malignant tumor// Embolic, Thromboembolic,

No. of Applicants : 40

▶ Correct Answer : 16/40,  40.0%
  • - Hospital of China Medical University, Taiwan, ROC Pan Sea-Harn
  • - Ondokuz Mayis University, Samsun, Turkey Cetin Celenk
  • - Nirman Hi-tech Diagnostic Center, Mumbai, India Minal Seth
  • - National Taiwan University Hospital, Taiwan Yu-Feng Wei
  • - DCA, New delhi Sriram Rajan
  • - M. Ravindranath SVS Diagnostics, Hyderabad, India Ravindranath Mallela
  • - SSG Hospital, Vadodara, India Mahavir Swami
  • - Sam Anyang Hospital, Korea Jae Seung Seo
  • - ... Nikhil Unune
  • - Mubarak Al Kabeer Hospital, Kuwait Varghese Sajeev PJ
  • - Homs National Hospital, Syria Rami Abou Zalaf
  • - CHU Grenoble, France Bing Fabrice
  • - Kangnam St. Mary Hospital, Korea Chae-Hun Lim
  • - Pgimer, Chandigarh, India Ram Prakash Galwa
  • - Pgimer, Chandigarh, India Krishna Prasad S
  • - MGM, Indore, India Sonali Jain
▶ Correct Answer as Differential Diagnosis : 16/40,  40.0%
  • - Inje University Ilsan Paik Hospital, Korea Bae Geun Oh
  • - Marien Hospital, Hamm, Germany Davis Chiramel
  • - AV Sint-Jan, Brugge Kristof De Cuyper
  • - Inha University Hospital, Korea Seung Woo Choi
  • - Sri Ravi Nursing Home, India Pavan Kumar Vodithala
  • - Fourth Terrace Diagnostic Center, Nassau, Bahamas Trupti Dabholkar
  • - Hangang Sacred Heart Hospital, Korea Eil Seong Lee
  • - Radiologie Guiton, La Rochelle, France Denis Chabassiere
  • - Monaldi Hospital, Naples, Italy Gaetano Rea
  • - Zulekha Hospital, Dubai Saurabh Khandelwal
  • - Zulekha Hospital, Dubai Julie Arora
  • - EKH, Berlin, Germany Michael Weber
  • - China Medical University Hospital,Taiwan Jun-Jun Yeh
  • - Diskapi Yildirim Beyazit Hospital, Ankara, Turkey Meric Tuzun
  • - Radiologie Guiton, La Rochelle, France Jean-luc Bigot
  • - Ultra Care, Coimbatore, India Debabrata Das
▶ Semi-Correct Answer : 4/40,  10.0%
  • - Kyungpook National University Hospital, Korea Wonho Lee
  • - Annemasse, Polyclinique de Savoie, France Gay-Depassier Philippe
  • - Airforce Hospital, Korea Hyun Seok Choi
  • - Incheon Sarang Hospital, Korea Jung Hee Kim
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