80-year-old male with bleeding via esophageal varices, portal and hepatic thromboses on abdominal ultrasound. Evaluate for portal and hepatic thrombosis. Evaluation for possible TIPS. Respiratory motion artifacts limit the exam.ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology. Persistent dilated gallbladder and nonspecific wall thickening, which is likely related to the cirrhosis and ascites. No intra or extrahepatic biliary ductal dilatation.There is occlusion and and expansion of both of the right hepatic vein (axial series 16 image 526) and posterior branch of the right portal vein (axial series 16 image 399). The main portal vein is patent, however there is partial thrombus within the proximal right portal vein (axial series 16 image 401). The anterior branch of the right portal vein is patent. As seen on the recent ultrasound exam, occlusion of the the middle hepatic vein is again noted (axial series 16 image 524). The left hepatic vein is not clearly delineated.A large enhancing tumor of hepatic segment 6/7 (axial series 16 image 68) measures 6.2 x 5.6 cm. The tumor demonstrates some restricted diffusion (axial series 8 image 124). There is a perfusional abnormality extending to the periphery due to the vascular thrombus. The delayed postcontrast series demonstrates questionable intratumoral washout (axial series 16 image 512).SPLEEN: The spleen is at the upper limits of normal in size measuring 11.4 cm in length.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple left renal cyst. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderate volume ascites.BONES, SOFT TISSUES: Anasarca of the abdominal wall, left greater than right.OTHER: Bilateral pleural effusions with overlying atelectasis. Infrarenal abdominal aortic aneurysm measuring 3.9 x 3.8 cm (axial series 16 image 20).
1.Occlusion of the right hepatic vein, middle hepatic vein, and posterior branch of the right portal vein.2.Enhancing tumor of hepatic segment 6/7 with questionable intratumoral washout in the liver with cirrhotic morphology. Occlusion and extension of the right hepatic vein and posterior branch right portal vein are concerning for tumoral invasion. Findings are suspicious of atypical hepatocellular carcinoma. Clinical correlation is needed.3.Infrarenal abdominal aortic aneurysm measuring 3.9 x 3.8 cm. 