The Chest Radiograph in Primary Liver Cancer

SA

7 Augustus 1976

MEDIESE

1323

TYDSKRIF

The Chest Radiograph in Primary Liver Cancer An Analysis of 449 Cases J. I. LEVY,

E. W. GEDDES,

SUMMARY The value of plain chest radiography in the diagnosis of primary hepatocellular cancer (PHC) was assessed In 449 patients. An elevated right hemidiaphragm and pulmonary metastases were present in 11 % and strongly suggest a diagnosis of PHC. In all, the right hemidiaphragm was raised in 30% of patients. Pulmonary metastases were present on admission in 19% of patients and appeared later in a further 6%. Secondary deposits were found in the lungs at necropsy in 52% of patients, compared with only 24% in whom there was radiological evidence of metastases during life. In 36% of patients chest radiographs were normal on admission.

S. Air. med. l., 50, 1323 (1976).

Primary hepatocellular cancer (pHC) is rare in most parts of the world, but occurs commonly in the Far East and in parts of Africa.'" The presence of a-fetoprotein in the serum of a proportion of patients with PHC: and the use of radionuclide liver scanning"· and hepatic arteriography' have greatly facilitated the diagnosis of this tumour. However, these techniques are not available in all medical centres, and least of all in those parts of the world where PHC is common. Facilities for plain radiography are more universally available, and we therefore decided to determine what pointers to the diagnosis of PHC, if any, could be obtained from plain chest radiographs.

PATIENTS AND METHODS For the past 9 years any Black mineworker suspected of having PHC has been admitted to the South African Primary Liver Cancer Research Unit. Postero-anterior and lateral chest radiographs have been taken as part of the investigation of nearly all of these patients. In those patients with PHC, radiography was repeated as often as was indicated, or at montWy intervals throughout their stay in hospital. To date 755 patients have been admitted to the unit, and chest radiographs of 703 of these patients were available for review. The diagnosis of PHC was confirmed Departments of Radiology and Medicine, Johannesburg General Hospital and University of the Wltwatersrand, and South African Primary Liver Cancer Research Unit, Johannesburg J. I. LEVY, M.B. B.CH., D.M.R.D., Principal Radiologist E. W. GEDDES, B.SC., M.B. B.CH., M.D., Senior Medical Officer M. C. KEW, PH.D., M.D., M.R.C.P., F.C.P. (S.A.), Pr'incipal Physician Date received:

9 February H76.

M. C. KEW

histologicaLly in 449 of these 703 patients. Hepatomegaly in the remainder had a variety of causes, usually cirrhosis, amoebic abscess metastatic liver disease, congestive cardiac failure, viral he~atitis or tuberculous hepatitis. The patients with PHC were commonly between the ages of 20 and 45 years and all were men. In order to ensure an objective assessment of the X-ray films, all 703 were examined by 2 of the authors (1. I. L. and M. C. K.), who did not know which patient had a primary tumour and which had another cause for hepatomegaly. In 189 of the patients in whom necropsy was performed, the prevalence of pulmonary metastases derived from radiological evidence was compared with the true prevalence as found at necropsy.

RESULTS The results of the chest radiographs of the 449 patients with PHC at the time of admission are summarised in Table 1. TABLE

I.

RESULTS OF CHEST RADIOGRAPHS PATIENTS WITH PHC ON ADMISSION Number

Normal chest Pulmonary metastases Elevated right hemidiaphragm Elevation of both domes of diaphragm Elevated left hemidiaphragm

163

OF 4