58-year-old female with PBC, cirrhosis, ascites. Evaluate strictures, biliary duct patency, pretransplant, cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology with sequelae of portal hypertension including a single dominant splenorenal shunt. The liver demonstrates right lobe atrophy, nodular border, and siderotic cirrhotic nodules. Superimposed on this are 3 large smooth homogeneous nodules/masses which have dramatically increased in size or are new since CT exam of March, 2016. The largest in the left hepatic lobe is hypointense on T2 measuring approximately 6 x 6 cm (series 5 image 15) and mildly hyperintense on T1. This lesion is isointense to the hepatic parenchyma all postcontrast phases (series 13 images 26, 120).The 2 lesions in the posterior right hepatic lobe are isointense on T2, hyperintense on T1, and show no restricted diffusion. The medial lesion measures 3.7 x 3.9 cm, and the lateral lesion measures 3.9 x 3.4 cm. On the 3/1/2016 CT exam, the lateral lesion in retrospect measured approximately 1.8 cm in diameter, and the medial lesion is not clearly identified retrospectively. Both lesions demonstrate diffuse substantial arterial enhancement with well-defined zones of washout on the venous phase and peripheral capsular enhancement on the delayed phase (series 13 image 400). The medial lesion also demonstrates focal early marked washout along the anterior border suggesting a "nodule within a nodule" appearance (series 13 image 302).Smaller bright T1 or hypointense T2 nodules are seen scattered about the liver of a small size and nonspecific, but mostly likely regenerative nodules or dysplastic nodules.There is focal dilatation of the proximal common hepatic duct measuring 12 mm in diameter (series 5 image 17) with attenuation of the right and left bile ducts. The common bile duct tapers smoothly, and there is no evidence for an obstructing lesion. This is new since the March 2016 CT examination, and is of uncertain significance and etiology.SPLEEN: Mild splenomegaly measuring 12.2 cm in length.PANCREAS: No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small left renal cyst. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Only scattered minimally prominent lymph nodes are seen in the upper abdomen. No enlarged suspicious nodes for neoplastic disease are seen.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild to moderate abdominal anasarca.OTHER: No significant abnormality noted.
1.Siderotic cirrhotic morphology.2.Rapid development of large homogeneous masses in the right and left hepatic lobes as described above. Two of these lesions meet AASLD criteria for HCC, however the unusual imaging spectrum in this patient with a history of PBC warrants biopsy for confirmation before presumptive diagnosis.3. Focal dilatation of the proximal common hepatic bile duct new since March, 2016m with normal smooth tapering of the common bile duct. No obstructing lesion. The common hepatic duct had a normal appearance on the 3/1/2016 CT exam. 4. Marked attenuation of the intrahepatic ducts typical of PBC with limited visibility, but no focal abnormality seen.