Evaluation of the viability of hepatocellular carcinoma in the caudate lobe using contrast-enhanced endoscopic ultrasonography after transarterial chemoembolization

A 71-year-old female was diagnosed with hepatocellular carcinoma (HCC). The tumor measured 65 mm in diameter and was located in the caudate lobe. Transarterial chemoembolization (TACE) was performed repeatedly; however, a follow-up dynamic computed tomography (CT) scan showed that the tumor remained viable. Thus, TACE was performed using drug-eluting beads that had been preloaded with epirubicin. Contrast-enhanced endoscopic ultrasonography (CE-EUS) was conducted for evaluating the treatment effects. First, we detected the internal part of the tumor. Then, a perflubutane suspension was injected intravenously. Next, CE-EUS was performed for the external ventral part of the tumor in the same manner. The perflubutane flowed into the tumor and spread into both its internal and external ventral regions. Thus, we considered that the tumor was still viable and planned to carry out TACE again. CE-EUS could be a useful tool for evaluating the treatment effects of TACE on HCC deep inside the liver.