RESUMEN
Hemoperitoneum in cirrhosis is a life-threatening condition that requires emergent evaluation. Contrast-enhanced ultrasound (CEUS) permits multiple dynamic characterizations of abdominal structures through all vascular phases, and contrast extravasation or the presence of microbubbles in the ascites could be a sensitive tool. We reviewed 13 patients with cirrhosis that underwent CEUS due to high suspicion for intra-abdominal bleeding. In 10 cases, CEUS demonstrated extravasation of contrast, including 2 instances where CEUS detected active bleeding despite negative computed tomography. These data support further study of CEUS in direct comparison to other imaging modalities in this clinical context.
Asunto(s)
Medios de Contraste , Hemoperitoneo , Humanos , Cirrosis Hepática , Ultrasonografía , Extravasación de Materiales Terapéuticos y DiagnósticosRESUMEN
Immune checkpoint inhibitors (ICI) have been used to treat hepatocellular carcinoma (HCC) since 2017. The safety of ICIs in the setting of solid organ transplantation remains controversial. When used in the post-transplant setting, ICIs have been associated with high allograft rejection rates, but there are few published reports on the use of ICIs prior to transplant. We present the first reported case of rescue liver re-transplantation after loss of the first allograft due to severe acute rejection with extensive hepatic necrosis in the setting of pre-transplant ICI therapy with the PD-1 inhibitor nivolumab. It is likely that the durable immune response triggered by nivolumab contributes to graft rejection, therefore extreme caution should be taken when using ICIs before transplant until further investigation has been conducted on their safety in the pre-transplant setting.
Asunto(s)
Carcinoma Hepatocelular , Neoplasias Hepáticas , Carcinoma Hepatocelular/tratamiento farmacológico , Carcinoma Hepatocelular/cirugía , Rechazo de Injerto/tratamiento farmacológico , Humanos , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Hepáticas/cirugía , Nivolumab/efectos adversosRESUMEN
The Liver Imaging Reporting and Data System (LI-RADS) provides standardized lexicon, technique, interpretation, and reporting of liver imaging in patients at risk for hepatocellular carcinoma (HCC). When applied to at-risk populations, LI-RADS achieves higher than 95% positive predictive value for the noninvasive diagnosis of HCC on computed tomography (CT), MRI and contrast-enhanced ultrasound (CEUS). This article focuses on similarities and differences between the CT/MRI diagnostic algorithm (CT/MRI LI-RADS) and the CEUS diagnostic algorithm (CEUS LI-RADS) to inform health care professionals for efficient and appropriate clinical decisions through the management of patients at risk.