PORTAL-VEIN THROMBOSIS COMPLICATING HEPATOCELLULAR-CARCINOMA - VALUE OF ULTRA SOUND-GUIDED FINE-NEEDLE BIOPSY OF THE THROMBUS IN THE THERAPEUTIC MANAGEMENT

During a 4-year period portal vein thrombosis was diagnosed in 20 Chil d class A patients with cirrhosis by means of ultrasound and ultrasoun d-Doppler study. Seventeen of them showed single or multiple focal liv er lesions diagnosed as hepatocellular carcinoma by ultrasound-guided fine-needle biopsy and the remaining three a coarse liver echo-pattern without focal lesions. One patient was found to have developed portal vein thrombosis after the fifth ethanol injection of a single hepatoc ellular carcinoma lesion 17 mm in diameter. Ultrasound-guided fine-nee dle biopsy of the thrombus was performed on all the patients: portal v ein thrombosis was neoplastic in 13 cases and non-neoplastic in seven cases (five patients with a single lesion; one with two lesions; one w ith coarse liver echo-pattern). Among the five patients with a single lesion, one had already been treated by percutaneous ethanol injection therapy. There were no complications related to the biopsy procedures . The diagnosis of non-neoplastic thrombosis allowed five new patients to be recruited for percutaneous ethanol injection treatment and allo wed it to continue in the patient with portal vein thrombosis occurrin g after the fifth ethanol injection. The routine use of ultrasound-gui ded fine-needle biopsy of portal vein thrombosis yields an accurate di agnosis of the nature of the thrombus and can improve the selection fo r percutaneous ethanol injection treatment of patients with cirrhosis with hepatocellular carcinoma lesions.