Suraj Menon MBBS, MRCP, Presenter: Nothing to Disclose

Shyam Sunder MD, FRCR, Abstract Co-Author: Nothing to Disclose

The purpose of this pictorial review is to illustrate the MDCT  findings of ruptured HCC; with specific reference to the "enucleation sign". Spontaneous rupture of HCCs (approx 10%) is often fatal, due to difficulty in acheiving hemostasis in a coagulopathic patient with cirrhotic liver. Prompt and early detection is crucial to expedite management.

Enucleation sign : so called, due to its similarity to an enucleated orbital globe with remaining sclera; is constituted by 1. a non enhancing low attenuation hepatic lesion with focal discontinuity and peripheral rim enhancement in the arterial phase, 2. separation of tumour content from the peripheral enhancing rim and intraperitoneal rupture of tumour content into the perihepatic space. Peripheral location, protruding contour, discontinuity of the hepatic surface are other useful signs.

It is hoped that this pictorial review of the CT signs of ruptured HCC's, i.e peripheral location, protrusion of contour, discontinuity of hepatic surface, surrounding haematoma with high attenuation, and last but not least "the enucleation sign"; will expedite prompt detection and management. In our experience, " the enucleation sign" has been very specific for ruptured HCCs. 

Menon, S, Sunder, S, "Enucleation Sign" in Multidetector Computed Tomography (MDCT) of Ruptured Hepatocellular Carcinoma (HCC) Portends Imminent Catastrophe: As Illustrated and Explained by This Pictorial Review.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6017725.html