AIH with cirrhosis, OLT evaluation ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Discrete hepatic segment 3 lesion measuring 2.1 x 1.8 cm (image 317 series 1006/image 317 series 1002), demonstrating apparent mild internal enhancement (however, evaluation suboptimal due to the later timing of the IV contrast bolus in sequence labeled arterial phase) with possible mild washout on subsequent delayed imaging, no corresponding restricted diffusion delineated. Signal drop out seen on opposed phase sequence, suggesting intravoxel fat within lesion. Lesion is mildly T1 hyperintense and T2 hypointense. Status post cholecystectomy. Patent portal veins, hepatic veins and hepatic arteries. Patent splenic vein and SMV. Dilatation of IVC, nonspecific, may be seen in setting of underlying heart failure. Incidentally visualized retroaortic left renal vein. Multiple upper abdominal varices. Moderate ascites.SPLEEN: Splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.BOWEL, MESENTERY: Thickening of colon particularly on the right suggested, may reflect underlying portal colopathy, generalized bowel wall thickening may also be seen in setting of hypoalbuminemia and ascites.BONES, SOFT TISSUES: Susceptibility artifact from postsurgical material in ventral abdominal wall.OTHER: Basilar atelectasis, small pleural effusions.
1. Cirrhotic liver with discrete hepatic segment 3 lesion as described, lesion does not meet the strict criteria for an HCC, imaging characteristics are suggestive of a dysplastic nodule. Tissue sampling suggested for more definitive characterization.2. Stigmata of hepatic cirrhosis and portal hypertension as above, including splenomegaly, variceal formation and diffuse bowel thickening. Thickening of colon particularly on the right suggested, may reflect underlying portal colopathy, generalized bowel wall thickening may also be seen in setting of hypoalbuminemia and ascites. Please note that thickening seen in region of patient's neoterminal ileum on prior CT imaging not well assessed on current exam.