A case of membranous obstruction of inferior vena cava at the hepatic associated with hepatocellular carcinoma and liver cirrhosis

: A case of inferior vena cava obstruction at the hepatic portion associated hepatocellular carcinoma with and liver cirrhosis is reported, which was treated with lateral segmentectomy of the liver after transcatheter angioplasty. A 36-year-old male, who had noticed venous dilatation in the abdominal wall and legs from his childhood, visited a doctor complaining of right upper quadrate pain and was diagnosed liver cirrhosis. One year later ultrasonography revealed a liver tumor, which was diagnosed as hepatocellular carcinoma by ultrasonically guided aspiration cytology. Inferior and superior vena cavography revealed complete membranous obstruction of inferior vena cava at the hepatic portion with marked collateral circulation through azygos, hemiazygos and phrenic veins. The caval pressure difference between above and below the obstruction was 16.5 cm H2O. The membranous obstruction was perforated and dilated by transluminal angioplasty using Dotter's balloon catheter. The obstructive segment of inferior vena cava changed into 8mm in diameter after the second angioplasty, and the caval pressure difference between above and below the stenosis decreased to 10 cm H2O. Lateral segmentectomy of the liver was performed. Histopathologic diagnosis was clear cell type hepatocellular carcinoma with liver cirrhosis. Marked postoperative liver damage was observed and transcatheter caval dilatation was performed again. The pressure of inferior vena cava below the stenosis decreased to 8 cm H2O. One year and 8 months after the operation, the patient is healthy without recurrence of cancer.