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英文誌(2004-)

Journal of Medical Ultrasonics

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1995 - Vol.22

Vol.22 No.10

Case Report(症例報告)

(0721 - 0728)

肝血管筋脂肪腫の超音波像

Ultrasonographic Appearance of Angiomyolipoma of the Liver

井利 雅信1, 渡邊 五朗1, 竹内 和男2, 松田 正道1

Masanobu IRI1, Goro WATANABE1, Kazuo TAKEUCHI2, Masamichi MATSUDA1

1虎の門病院消化器外科, 2虎の門病院消化器内科

1Department of Surgery, Toranomon Hospital, 2Department of Gastroenterology, Toranomon Hospital

キーワード : Acoustic shadow, Hepatic angiomyolipoma, Hepatic hemangioma, Hepatic hyperechoic tumor, Ultrasonography

We report two cases of clinically rare angiomyolipomas of the liver and their ultrasonographic appearance. Case 1 was that of a 68-year-old woman with cancer of the transverse colon who had a preoperative ultrasonographic examination that disclosed a hyperechoic knobby tumor in the liver. The tumor had a well-defined, slightly irregular contour measuring 3.5 cm in diameter at the surface of segment 8. It was brighter than the usual hemangioma and had a slight acoustic shadow. A postcontrast CT scan revealed a low-density mass with a clear margin, suggesting a fat component. The density of the marginal part was high. Abdominal digital subtraction angiography showed a markedly hypervascular tumor in the arterial phase and heterogeneous tumor staining in the capillary phase. The transverse colon and part of segment 8 of the liver were resected. Histological diagnosis showed the lesion to be a hepatic angiomyolipoma consisting of mature fat cells, vessels, and smooth-muscle tissues. In case 2, routine physical examination disclosed a hepatic hemangioma in a 40-year-old man. He was admitted to this institution because of epigastralgia. Ultrasonography disclosed a hyperechoic knobby tumor with a well-defined, slightly irregular contour measuring 3.5 cm in diameter at the surface of segment 8 of the liver. This, too, was brighter than usual hemangioma with a clear acoustic shadow, and abdominal CT scan and digital subtraction angiography showed findings similar to those reported in case 1. Both T1- and T2-weighted images showed high intensity on abdominal MRI study. Part of liver segment 8 was resected; the histological diagnosis was hepatic angiomyolipoma. In this case, there were hepatocytes and foamy macrophages among the fat cells. Ultrasonographic findings of a hepatic angiomyolipoma have been reported to be a hyperechoic knobby tumor with a well-defined and slightly irregular contour. The echogenecity of the tumor is brighter than that of the usual hemangioma, and the tumor sometimes has an acoustic shadow. An acoustic shadow behind a bright hepatic tumor like those described here may provide a clue for diagnosing angiomyolipomas.