62-year-old male with cirrhosis on heparin drip, supratherapeutic. Now with hemoglobin drop. Concern for hematoma and liver. Per medical record, history of cirrhosis (HCV, EtOH, HCC) s/p transplant in 2009 c/b relapsed HCV, portal vein thrombosis, grade III esophageal varices and grade I gastric variceal bleed with emergent TIPS in May 2015. Multiple sequences are limited by dielectric artifact secondary to the patient's ascites.ABDOMEN:LUNG BASES: Small bilateral pleural effusions with bilateral lower lobe atelectasis.LIVER, BILIARY TRACT: 11.0 x 8.7 x 8.7 cm lobulated septated mass in the right hepatic lobe, with homogeneous internal low T1 signal, internal high T2 signal, and mild peripheral enhancement without internal enhancement. This is similar to the prior CT on 7/4/2015, though new since 5/21/2015. Geographic regions of high T2 signal in the posterior right hepatic lobe are compatible with fibrosis and steatosis, also seen on prior CTs. There is biliary ductal dilation in the posterior right hepatic lobe, possibly secondary to compression by the aforementioned mass. The TIPS is again seen, in similar configuration to prior studies.SPLEEN: Splenomegaly with siderotic nodules.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate amount of ascites, similar to the prior CT, though increased since the prior MRI in 2014. Anasarca.
11 cm lobulated septated mass in the right hepatic lobe without internal enhancement and questionable rim enhancement. This appearance is nonspecific though abscess and hematoma should be considered.