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Wang A, Chen H, Huang Z, Tang H, Shi H, Wen J, Li Q, Jiang Y, Fu W. Spontaneous internal hemorrhage of a giant hepatic hemangioma with infection: a case report and literature review. J Int Med Res 2021; 48:300060520976474. [PMID: 33284661 PMCID: PMC7724420 DOI: 10.1177/0300060520976474] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Spontaneous internal hemorrhage from a hepatic hemangioma is rare. This case
describes a 59-year-old woman who was hospitalized with recurrent cough and
fever for 6 months. The doctor thought that she had pneumonia, but other
infectious diseases could not be ruled out. Therefore, related tests were
performed and strong antibiotics were used, but the symptom of fever was
persistent and recurred. Enhanced computed tomography (CT) findings showed a
right hepatic giant hemangioma with hemorrhage, while tuberculosis, liver
abscess, and immune disease were excluded by the physician. Because the
patient’s fever was associated with a large hepatic hemangioma, the patient was
transferred to surgery. During treatment, the amount of bleeding increased, so
she underwent a right hepatic hemangioma resection in the emergency department.
Her postoperative fever symptoms subsequently resolved. Pathological examination
confirmed hemorrhagic necrosis with infection in hepatic hemangioma. Follow-up
showed that the patient was afebrile.
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Affiliation(s)
- Ankang Wang
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Sichuan, China.,Department of General Surgery, Nanchong Central Hospital, The second Clinical College of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Hao Chen
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Sichuan, China
| | - Zhiwei Huang
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Sichuan, China
| | - Hong Tang
- Department of Pathology, The Affiliated Hospital of Southwest Medical University, Sichuan, China
| | - Hao Shi
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Sichuan, China
| | - Jian Wen
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Sichuan, China
| | - Qiu Li
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Sichuan, China
| | - Yu Jiang
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Sichuan, China
| | - Wenguang Fu
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Sichuan, China
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Yang YG, Chen WF, Mai WH, Li XF, Zhou HL, Liu LJ, Li MY. Spontaneous intracapsular hemorrhage of a giant hepatic cavernous hemangioma: a rare case report and literature review. BMC Gastroenterol 2021; 21:84. [PMID: 33622256 PMCID: PMC7903738 DOI: 10.1186/s12876-021-01666-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/12/2021] [Indexed: 11/28/2022] Open
Abstract
Background Hepatic cavernous hemangioma is the most common type of benign liver tumor. Although ruptures and hemorrhages of hepatic hemangioma are rare complications, they are associated with high mortality. Most practitioners only pay more attention to abdominal hemorrhages caused by the rupture of hepatic hemangiomas. However, spontaneous intracapsular hemorrhages can often be neglected and poorly understood. Case presentation A 65-year-old man was referred to our institution with right upper quadrant pain, which had occurred suddenly and without a history of recent trauma. The blood test results were normal. Magnetic resonance imaging (MRI) of the abdomen showed a cystic mass in the right liver lobe. Considering the possibility of hepatic cystadenoma with hemorrhage, the patient underwent a right hepatic lobectomy. The pathological findings unexpectedly revealed intratumoral hemorrhage of hepatic hemangioma. The patient recovered well and was discharged eight days after surgery. Conclusions Intracapsular hemorrhage of hepatic cavernous hemangioma is challenging to diagnose and has a high potential risk of rupture. MRI is beneficial for diagnosing subacute internal hemorrhage cases, and it is recommended to undergo surgery for patients with a definitive diagnosis.
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Affiliation(s)
- Yong-Guang Yang
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, People's Republic of China
| | - Wei-Feng Chen
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, People's Republic of China
| | - Wei-Heng Mai
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, People's Republic of China
| | - Xiao-Fang Li
- Department of Pathology, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, People's Republic of China
| | - Hong-Lian Zhou
- Department of Ultrasound Diagnostics, Guangdong Province, The Affiliated Hospital of Guangdong Medical University, 57th, Renmin South Road, Xia shan District, Zhanjiang, 524001, People's Republic of China
| | - Li-Juan Liu
- Department of Ultrasound Diagnostics, Guangdong Province, The Affiliated Hospital of Guangdong Medical University, 57th, Renmin South Road, Xia shan District, Zhanjiang, 524001, People's Republic of China.
| | - Ming-Yi Li
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, People's Republic of China
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Dane B, Shanbhogue K, Menias CO, Taffel MT. The humbling hemangioma: uncommon CT and MRI imaging features and mimickers of hepatic hemangiomas. Clin Imaging 2021; 74:55-63. [PMID: 33434867 DOI: 10.1016/j.clinimag.2020.12.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/12/2020] [Accepted: 12/01/2020] [Indexed: 11/29/2022]
Abstract
Cavernous hemangiomas are among the most common liver lesions encountered in abdominal imaging. While classical imaging characteristics usually aid the radiologist in confidently arriving at its diagnosis, atypical hemangiomas can prove to be difficult to distinguish from other more worrisome hepatic lesions such as metastases and hepatocellular carcinoma. Furthermore, some malignant lesions can display features that simulate hemangiomas. The radiologist must be aware of these pitfalls to make an accurate diagnosis, when possible.
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Affiliation(s)
- Bari Dane
- NYU Langone Health, Department of Radiology, United States of America.
| | | | - Christine O Menias
- Mayo Clinic, Department of Radiology, Scottsdale, AZ, United States of America
| | - Myles T Taffel
- NYU Langone Health, Department of Radiology, United States of America
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Abstract
RATIONALE Hepatic hemangioma, a benign liver tumor, can rarely spontaneously rupture and hemorrhage, which is then associated with significant mortality. The diagnosis of internal hemorrhage is challenging and the management is disputed. PATIENT CONCERNS We describe the case of a 52-year-old female patient with chief complaints of fever and anemia, with no history of recent trauma. DIAGNOSES Ultrasound suggested the possibility of a liver abscess and computed tomography (CT) examination revealed a giant space occupying lesion (SOL) (approximately 16 cm) in the right hepatic lobe, indicating a hepatic tumor or abscess. The patient did not respond to antibiotics and blood transfusion. Liver needle biopsy revealed blood clots suggestive of intratumoral hemorrhage, possibly of a hepatic hemangioma. INTERVENTIONS Interventional radiologic approach revealed active bleeding at the phrenic artery that supplied the liver SOL. Thus, embolization was performed and re-angiography showed no active bleeding from the embolized vessel. The patient became afebrile, but fever recurred the next day. Hence, an exploratory open right hemihepatectomy was undertaken and the intraoperative frozen biopsy confirmed hepatic hemangioma with internal hemorrhage, but malignancy could not be excluded for some focal tissues. Postoperative pathology report confirmed the diagnosis of hepatic hemangioma with internal hemorrhage and excluded malignancy. OUTCOMES The fever subsided and the patient was discharged in good health. A follow-up CT performed three months, postoperatively, indicated compensatory growth of the left hepatic lobe. LESSONS This case demonstrates that the diagnosis of hepatic hemangioma with internal hemorrhage can be confirmed by needle biopsy and surgical resection is the optimal treatment for such a lesion.
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Affiliation(s)
- Fulong Hao
- Department of Hepatobiliary Surgery, Suining Central Hospital
| | - Xiaoli Yang
- Department of Hepatobiliary Surgery, Suining Central Hospital
| | - Yinsheng Tian
- Department of Hepatobiliary Surgery, Suining Central Hospital
| | - Wenping Wang
- Department of Infectious Diseases, Suining Central Hospital, Suining, Sichuan, China
| | - Minggang Ge
- Department of Hepatobiliary Surgery, Suining Central Hospital
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Donati M, Stavrou GA, Donati A, Oldhafer KJ. The risk of spontaneous rupture of liver hemangiomas: a critical review of the literature. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2016; 18:797-805. [PMID: 21796406 DOI: 10.1007/s00534-011-0420-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The risk of spontaneous bleeding or rupture of liver hemangiomas still remains unknown. The aim of this review was to analyze the problem of spontaneous bleeding or rupture in liver hemangiomas and to identify factors leading to bleeding in these cases. METHODS A MEDLINE search was undertaken to identify articles in English, French, German, Italian, and Spanish from 1898 to 2010. Basic data such as age and sex of patients were collected. Additional data such as risk factors or causes of rupture were also analyzed. Cases were divided into spontaneous and non-spontaneous ruptures. RESULTS A total of 97 cases are described. In 51 of the 97 patients (52.6%) a non-spontaneous rupture was identified. Only in 46 out of the 97 cases (47.4%) was a spontaneous rupture found. Non-spontaneous rupture was significantly more frequent in patients aged <40 years than in older ones (p = 0.0099). Mean size of the ruptured lesions was 11.2 cm (range 1-37 cm). Massive bleeding occurred in 88 patients (90.7%). Reported mortality over the past 20 years has been significantly lower than before (p < 0.001). The overall mortality for the period under study was ~35%. CONCLUSIONS The spontaneous rupture of a hepatic hemangioma is to be considered an exceptional event. Preventive surgery should be considered only for lesions of at least 11-cm size in special cohorts of patients.
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Affiliation(s)
- Marcello Donati
- Department of General and Abdominal Surgery, Asklepios Hospital Barmbek, Asklepios Medical School, Rübenkamp 220, Hamburg, Germany.
- Department of Surgical Science, Organ Transplants and New Technologies, General Surgery and Week Hospital, University Hospital of Catania, Catania, Italy.
| | - Gregor A Stavrou
- Department of General and Abdominal Surgery, Asklepios Hospital Barmbek, Asklepios Medical School, Rübenkamp 220, Hamburg, Germany
| | - Angelo Donati
- Department of Surgical Science, Organ Transplants and New Technologies, General Surgery and Week Hospital, University Hospital of Catania, Catania, Italy
| | - Karl J Oldhafer
- Department of General and Abdominal Surgery, Asklepios Hospital Barmbek, Asklepios Medical School, Rübenkamp 220, Hamburg, Germany
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Kim JM, Chung WJ, Jang BK, Hwang JS, Kim YH, Kwon JH, Choi MS. Hemorrhagic hemangioma in the liver: A case report. World J Gastroenterol 2015; 21:7326-7330. [PMID: 26109822 PMCID: PMC4476897 DOI: 10.3748/wjg.v21.i23.7326] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 03/25/2015] [Accepted: 04/28/2015] [Indexed: 02/06/2023] Open
Abstract
Hemangioma is the most common type of benign tumor that arises in the liver. Although rupture and hemorrhage of hepatic hemangioma are rare complications, they can be the cause of mortality. The authors report a case of hemorrhagic hepatic hemangioma: in a 54-year-old woman who was admitted with epigastric pain. She had taken oral contraceptives several weeks prior. The results of a blood examination were normal. An abdominal computed tomography scan revealed a tumor in hepatic segment 4, and a hemorrhage inside the cystic mass was suspected. The mass was removed laparoscopically to confirm the tumor properties and control the hemorrhage. The pathologic findings of the resected mass were consistent with hepatic hemangioma with intratumoral hemorrhage. The patient was discharged 8 d after the surgery, without further complications or complaints, and the patient’s condition was found to have improved during follow-up.
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Markovic MV, Petricusic L, Curic J, Forstner R, Banic M. Magnetic resonance imaging of chronic bleeding into a giant hepatic hemangioma. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.ejrex.2010.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Choi J, Lee YJ, Hwang DW, Chon SH, Nagpal A, Park KM. Surgical Treatment of Giant Hepatic Hemangiomas: Technical Point of View. Am Surg 2011. [DOI: 10.1177/000313481107700120] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Hepatic hemangiomas are the most common benign tumors of the liver. Surgical treatment can be difficult as a result of the high risk of intraoperative hemorrhage. The present study reviewed clinical features of patients with hepatic hemangioma and surgical techniques used in their treatment. Eight patients with giant hepatic hemangiomas underwent hepatectomies at the Asan Medial Center between January 2006 and March 2009. Patient demographic, clinical, and surgical characteristics and outcomes were reviewed retrospectively. Seven females and one male patient underwent hepatectomies during the study period. The median age was 48.5 years (range, 33 to 58 years). Indications for surgical interventions were abdominal pain (62.5%), an abdominal mass (37.5%), Kasabach-Merritt syndrome (25%), and increased hemangioma size (25%). The hemangiomas were usually multiple (87.5%) and bilobar (75%) and had a median size of 14.5 cm (range, 7 to 29 cm). All patients underwent major hepatic resection with early vascular control using the Glissonean pedicle transection method (GPTM), the liver hanging maneuver (LHM), and preparation for total vascular exclusion (TVE). There was no major morbidity or mortality. The minor morbidity rate was 25 per cent with transfusion rate of 37.5 per cent. Early vascular control using the GPTM, the LHM, and preparation for TVE is essential for safe resection of large hepatic hemangiomas.
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Affiliation(s)
- Julian Choi
- Division of Hepato-Biliary & Pancreas Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Korea
| | - Young-Joo Lee
- Division of Hepato-Biliary & Pancreas Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Korea
| | - Dae Wook Hwang
- Division of Hepato-Biliary & Pancreas Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Korea
| | - Sang-Hoon Chon
- Division of Hepato-Biliary & Pancreas Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Korea
| | - Anish Nagpal
- Department of Surgery, Haribhakti Surgical Hospital, Ahmedabad, India
| | - Kwang-Min Park
- Division of Hepato-Biliary & Pancreas Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Korea
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Papafragkakis H, Moehlen M, Garcia-Buitrago MT, Madrazo B, Island E, Martin P. A case of a ruptured sclerosing liver hemangioma. Int J Hepatol 2011; 2011:942360. [PMID: 21994877 PMCID: PMC3170855 DOI: 10.4061/2011/942360] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Accepted: 04/11/2011] [Indexed: 11/29/2022] Open
Abstract
Hemangiomas are the most common benign tumors found in the liver, typically asymptomatic, solitary, and incidentally discovered. Although vascular in nature, they rarely bleed. We report a case of a 52-year-old woman with a previously stable hemangioma who presented to our hospital with signs and symptoms indicative of spontaneous rupture. We review the literature, focusing on diagnosis and management of liver hemangiomas.
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Affiliation(s)
- Haris Papafragkakis
- Division of Hepatology, University of Miami Miller School of Medicine, 1500 NW 12th Avenue, Suite 1101, Miami, FL 33136, USA,*Haris Papafragkakis:
| | - Martin Moehlen
- Division of Hepatology, University of Miami Miller School of Medicine, 1500 NW 12th Avenue, Suite 1101, Miami, FL 33136, USA
| | - Monica T. Garcia-Buitrago
- Department of Pathology, University of Miami Miller School of Medicine, 1611 NW 12th Avenue, Holtz Building, Room 2042, Miami, FL 33136, USA
| | - Beatrice Madrazo
- Department of Radiology, University of Miami Miller School of Medicine, 1611 NW 12th Avenue, Miami, FL 33136, USA
| | - Eddie Island
- Miami Transplant Institute, University of Miami Miller School of Medicine, Highland Professional Building, 1801 NW 9th Avenue, 3rd Floor, Miami, FL 33136, USA
| | - Paul Martin
- Division of Hepatology, University of Miami Miller School of Medicine, 1500 NW 12th Avenue, Suite 1101, Miami, FL 33136, USA
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Brogna A, Ferrara R, Bucceri AM, Virgilio C, Scalisi G. An atypical case of hepatic cavernous hemangioma. CASES JOURNAL 2009; 2:181. [PMID: 19946491 PMCID: PMC2783136 DOI: 10.1186/1757-1626-2-181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Accepted: 11/02/2009] [Indexed: 11/10/2022]
Abstract
INTRODUCTION The case of an atypical hepatic angiocavernoma is referred. The lesion, first described as a hypoechogenic area compared to the surrounding parenchyma, with anechogenic shoots inside, suggestive for vascular structures developed one year later into a totally asonic area with frayed margins. This change is very unusual and uncommon for this kind of lesions. CASE PRESENTATION The case of a 74-year old caucasian male, complaining of slight dyspeptic symptoms (post-prandial fullness and bloating) is referred. The routine blood tests were all normal. Abdominal ultrasound showed a large, roughly round-shaped lesion (diameter 14 cm) in the VIII hepatic segment diagnosed as hepatic angiocavernoma, which turned unexpectedly in a cystic like lesion one year later. CONCLUSION The atypical angioma's degeneration could account for one of the causes of the patient's exitus. It could be related to blood seizure by the large hepatic angioma due to the intratumoural haemorrhage.
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Affiliation(s)
- Alfio Brogna
- Department of Internal Medicine, Gastroenterology Unit, S. Luigi Hospital, Viale Fleming 24, 95100, Catania, Italy.
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Fan RF, Chai FL, He GX, Wei LX, Li RZ, Wan WX, Bai MD, Zhu WK, Cao ML, Li HM, Yan SZ. Laparoscopic radiofrequency ablation of hepatic cavernous hemangioma. A preliminary experience with 27 patients. Surg Endosc 2005; 20:281-5. [PMID: 16362478 DOI: 10.1007/s00464-005-0184-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2005] [Accepted: 09/27/2005] [Indexed: 12/17/2022]
Abstract
BACKGROUND Radiofrequency ablation (RFA), currently used extensively for liver tumors, also has been applied successfully to hepatic cavernous hemangioma (HCH) percutaneously. The aim of this study was to assess the feasibility, safety, and efficacy of laparoscopic RFA for patients with HCHs. METHODS Between March 2001 and March 2004, 27 patients with symptomatic and rapid-growth lesions were treated by laparoscopic RFA using the RF-2000 generator system. The treatment-related complications were observed. All the patients were followed up with helical computed tomography scans and ultrasonography at regular intervals to assess the therapeutic efficacy of laparoscopic RFA. RESULTS This study assessed 9 men and 18 women with a mean age of 41.6 +/- 8.3 years. Three additional intrahepatic lesions missed preoperatively were found in three patients on intraoperative ultrasound. A total of 27 patients with 50 liver lesions were treated successfully with laparoscopic RFA. The mean maximum tumor diameter was 5.5 +/- 2.0 cm. The mean length of time for RFA per lesion was 20.7 +/- 11.9 min, and the mean blood loss was 134.4 +/- 88.9 ml. Laparoscopic cholecystectomy was performed simultaneously for gallstones in 13 patients and for abutting of gallbladder from hemangioma in 2 patients. In addition, 3 patients also had a laparoscopic deroofing of simple hepatic cysts. Although postoperative low-grade fever and transient elevation of serum transaminase levels were observed in 13 patients, there were no complications related to laparoscopic RFA. During a median follow-up period of 21 months (range, 12-42 months), complete lesion necrosis was achieved for all the patients. CONCLUSIONS Laparoscopic RFA therapy is a safe, feasible, and effective treatment option for patients with symptomatic and rapid-growth HCHs located on the surface of the liver or adjacent to the gallbladder. Intraoperative ultrasonography is a useful adjunct for detecting additional liver lesions and offering more accurate targeting for RFA.
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Affiliation(s)
- R-F Fan
- Department of Hepatobiliary Surgery, Lanzhou General Hospital of Lanzhou Military Region, People's Liberation Army, No. 58 Western Xiaoxihu Street, Lanzhou, 730050, Gansu, People's Republic of China.
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