文档介绍：Aimee M. Crago, HMS IVGillian Lieberman, MD Perioperative management of liver transplantation Aimee M. Crago, HMS Year IV Gillian Lieberman, MD March 17, 2003 2 Aimee M. Crago, HMS IVGillian Lieberman, MD . is a . man with liver mass ? The patient presented to his PCP for an annual examination and routine follow-up. ? His PMH was significant for hepatitis B virus (HbsAg positive at time of presentation) and cirrhosis. ? Blood tests detected elevated levels of the tumor marker AFP ( to a normal value between 0-7). This result raised concern that the patient had developed hepatocellular carcinoma (HCC), mon sequela of cirrhosis. ? The patient underwent ultrasound which demonstrated a 10cm mass in the right hepatic lobe. 3 Aimee M. Crago, HMS IVGillian Lieberman, MD This is a classic presentation for HCC. ? Chronic hepatitis B or C virus infection and cirrhosis are risk factors for the disease. ? Patients such as . are as ymptomatic until late in the course of the disease. ? Because of this fact, unless regular surveillance is performed, at time of presentation on 30% are surgically resectable. ? Symptoms in advanced disease may present as – Obstructive jaundice represen ting bile duct obstruction – Diarrhea representing malabsorption or paraneoplastic syndrome – Bone pain or dyspnea reflecting metastasis – Peritoneal bleed from tumor rupture – Paraneoplastic syndromes (hyp oglycemia, erythrocytosis, hypercalcemia, watery diarrhea, cutaneous change). 4 Aimee M. Crago, HMS IVGillian Lieberman, MD Four main roles for imaging in this patient’s medical management I. Identification and diagnosis of HCC II. Staging and determination of therapeutic strategy III. Identification of anatomical variants of import in surgical planning IV. Post-operative surveillance and diagnosis of complications 5 Aimee M. Crago, HMS IVGillian Lieberman, MD Differential diagnosis of a liver mass Vascular lesions ? Cavernous hemagioma ? Hemangioendothelioma