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Journal of Medical Ultrasonics

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1997 - Vol.24

Vol.24 No.05

Case Report(症例報告)

(0787 - 0794)


Hyperplastic Nodule of the Liver with Aberrant Right Gastric Vein Drainage: Observation by Color Doppler Imaging

栃尾 人司1, 岡部 純弘2, 冨田 周介2, 織野 彬雄2, 岩崎 信広1, 簑輪 和士1, 曽我 登志子1, 田村 周二1, 森本 義人1, 渡辺 智裕2, 福永 豊和2, 近藤 雅彦2, 樫田 博史2, 平佐 昌弘2, 伊吹 康良2, 工藤 正俊2, 藤堂 彰男2

Hitoshi TOCHIO1, Yoshihiro OKABE2, Syusuke TOMITA2, Akio ORINO2, Nobuhiro IWASAKI1, Kazushi MINOWA1, Toshiko SOGA1, Syuji TAMURA1, Yoshito MORIMOTO1, Tomohiro WATANABE2, Toyokazu FUKUNAGA2, Masahiko KONDO2, Hiroshi KASHIDA2, Masahiro HIRASA2, Yasuyoshi IBUKI2, Masatoshi KUDO2, Akio TODO2

1神戸市立中央市民病院臨床病理科腹部超音波検査室, 2神戸市立中央市民病院消化器センター内科

1Division of Abdominal Ultrasound, Kobe City General Hospital, 2Department of Gastroenterology, Kobe City General Hospital

キーワード : Aberrant gastric vein, Color Doppler ultrasonography , Hyperplastic nodule , Liver cirrhosis

Sonographic examination demonstrated a roundish, well-demarcated hypoechoic nodule approximately around 2 cm in diameter in the quadrate lobe (segment IV) of the liver of a 56-year-old man with chronic hepatitis C. Abundant flow signals of constant waveform were detected within the lesion on color Doppler examination. Blood flowed into the lesion from the peripheral side of the quadrate lobe and ran in the opposite direction of normal flow in the pertinent branch of the portal vein. A dynamic helical computed tomographic study failed to depict the nodule. The lesion appeared slightly hyperintense in T 1-weighted images and moderately hypointense in T 2-weighted images. The lesion appeared as a hot spot in colloid scintigraphy with 99mTc-phytate as well as in hepatocyte asialoglycoprotein receptor imaging with 99mTc-GSA. X-ray digital subtraction angiography failed to demonstrate the nodule, but ultrasound angiography with intraarterial infusion of carbon dioxide microbubbles confirmed that the lesion was hypovascular. The lesion was demonstrated as a perfusion defect on computed tomography during arterial portography. Ultrasound-guided needle biopsy showed a hyperplastic lesion without malignant findings. The abnormal area in question was not well irrigated by either the artery or the portal vein; therefore, the continuous flows shown by color Doppler sonography are attributable to aberrant gastric venous drainage, which has been reported by Matsui et al. The lesion is thus considered to be a focal hyperplasia of hepatocytes that we presume to have been caused by abnormal blood inflow from the stomach.