Liver metastasis-portal vein embolization
Known case of colon cancer with multiple right liver lobe metastases, candidate for right hepatectomy
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Multiple hypovascular masses are visible in the right lobe of the liver in favor of metastases. Just two small metastatic lesions are present in the left liver lobe, in the inferior of segment III. Evidence of right portal vein embolization is seen as non-opacification of the right portal vein and hyperdense foci at the course of the right portal vein intrahepatic branches. The colon is not visible at the normal anatomical location suggestive of previous total colectomy.
When a patient is a candidate for hepatectomy for metastatic or primary hepatic tumors, portal vein embolization may be indicated if the future liver remnant estimate was small. On this procedure, the lobe's portal vein, which contains lesions and scheduled for resection, should be occluded by the percutaneous injection of an embolizing agent. As a result, the portal flow to the contralateral hepatic lobe increased, inducing hypertrophy. A tumoral lesion on the contralateral lobe may be increased in size after embolization because of increased portal flow. Embolization could be performed with several types of embolizing material such as glue, lipiodol, Onyx, or the coil. In this patient, a mixture of glue and lipiodol was used for embolization.