Transcatheter arterial chemoembolization - before and after

Case contributed by Yaïr Glick


Abdominal pain in an end-stage renal failure patient on dialysis.

Patient Data

Age: 70 years
Gender: Male

Cirrhotic liver. Subcapsular slightly hypodense mass in segment 8 measuring 4.2 x 4.4 x 3.2 (TRV x AP x CC) cm, mildly hyperenhancing at the arterial phase and already hypoenhancing at the portal phase. Radiographic features and presence of cirrhosis favor hepatocellular carcinoma (HCC), with focal nodular hyperplasia (FNH) on the differential list.
Ascites, moderate amount. Extensive omental stranding, probably due to ascites alone.

The gallbladder contains small stones.
The spleen is enlarged, of normal density.
Atrophic kidneys.
Several diverticula in the distal descending and proximal sigmoid colon.
Status post prostatectomy. Few gold seeds for brachytherapy have remained in situ.

Chronic compression fracture of L3 vertebra, with moderate loss of height. Anterolisthesis, grade 1, of L4 on L5.
Healed fractures in several consecutive ribs on both sides. Old fractures with nonunion in superior and inferior right pubic rami

The hepatic mass was biopsied. Histopathology: hepatocellular carcinoma. Further imaging and cytology samples from several sessions of paracentesis showed no evidence of metastatic disease.
The patient received one round of transcatheter arterial chemoembolization (TACE).

Had a repeat CT abdomen for abdominal pain and vomiting one month after the previous exam shown above.