CT-guided percutaneous ethanol injection therapy for ultrasonically invisible hepatocellular carcinoma

We report the case of a 75-year-old woman with hepatitis C virus-related cirrhosis and recurrent hepatocellular carcinoma located just beneath the diaphragm. Computed tomography-guided percutaneous ethanol injection therapy was performed, because images of the tumor were hard to obtain on ultrasonography. The angle and depth of needle insertion were determined by using the geometric relationship between the target lesion and the skin insertion site on computed tomography scans. A 22-gauge needle was inserted through the right 6th intercostal space under local anesthesia. Computed tomography scanning was repeated to verify the needle position. After entry of the needle into the target lesion was confirmed, 10 mL of absolute ethanol was injected. This procedure caused transient mild pain, but there were no serious adverse effects such as pneumothorax or hemothorax. Three months after treatment, the lesion was not enhanced on dynamic computed tomography scanning, suggesting complete tumor ablation. At present, the patient is doing well. In conclusion, computed tomography-guided percutaneous ethanol injection therapy was safe and accurately achieved the desired tumoricidal effect in a patient with ultrasonically invisible hepatocellular carcinoma.