2013-05-23 14:18:09 UTC

Dyspnea and Shoulder Pain in a Patient With Hepatocellular Carcinoma

May 30, 2013

GuptaThe Clinical Gastroenterology and Hepatology image of the month showcases a 36-year-old man diagnosed with hepatitis B–related hepatocellular carcinoma and experiencing dyspnea and shoulder pain.

GuptaThe Clinical Gastroenterology and Hepatology image of the month showcases a 36-year-old man diagnosed with hepatitis B–related hepatocellular carcinoma for two years. Because there were multiple tumors, he had undergone transarterial chemoembolization for tumor burden control six times. During follow-up evaluation, multiple lung metastases were found, and sorafenib was added for six months. He suffered from severe pain in his right shoulder and back, accompanied by shortness of breath, so he underwent further evaluation. Pale appearance and decreased right-lung breath sounds were noted on physical examination. Chest radiograph showed a massive right pleural effusion in addition to the lung nodules (Figure A), compared with one month ago when only multiple nodules in both lungs were present (Figure B). CT showed massive right pleural effusion, bilateral lung nodules, pleural and diaphragm seeding of tumors, and large hepatic tumors with partial Lipiodol retention (Figure C). Thoracocentesis revealed bloody pleural effusion. He underwent pleurodesis after pigtail drainage of the hemothorax. A small amount of pleural effusion was noted two weeks after discharge (Figure D).

Read the full CGH article to see his diagnosis.

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