Angiographic, ultrasound and isotopic scanning in the evaluation of hepatic masses.

We selected 24 patients with hepatic masses in which hepatic angiography ultrasound and isotopic scanning were performed. All the patients had exploratory laparotomy with pathological diagnosis. The clinical data are summarized on Table 1. In the group of malignant primary hepatic tumors we included 7 hepatomas, 1 hepatoblastoma and 1 cholangiocar cinoma. Case 1 was an assymptomatic 27 years old black female with a mass in the right upper quadrant (RUQ) for 3 years. The angiogram showed extensive neovascularity sup plied by the right hepatic artery (Fig. 1) originated from the superior mesenteric artery (SMA) that was displaced to the left side. The left hepatic artery was normal (Fig. 2) and at laparotomy an hepatoma limited to the right lobe was con firmed and right lobectomy was done. On the remaining he patomas and hepatoblastoma both lobes of the liver were involved (Fig. 3, 5). In case 4 on late films of the hepatic arteriogram there was filling defect on the portal vein due to tumor invasion (Fig. 4). In all of our malignant primary tumors hepatic artery was dilated. Encasement was showed only in the case of cholangiocarcinoma (Fig. 8). The arterio gram on this case showed in the late phase (Fig. 9) heteroge nous tumor staining with central lucency due to necrosis that was found at laporatomy. The echography performed showed a solid mass on the liver in 5 out of the 7 hepatomas and in the case of hepato blastoma. s9mTc performed showed a defect in the liver in 4 out of the 7 hepatomas and in the case of hepatoblastoma. In the case of cholangiocarcinoma both ultrasound and nuclear medicine were negative.