Male 72 years old Reason: liver lesion History: liver lesion ABDOMEN:LIVER, BILIARY TRACT: Liver has mildly widened fissures and hypertrophy of the caudate compatible with chronic liver disease. There is a multilobular mildly T2 hyperintense lesion involving the right hepatic lobe representing a conglomerate lesion composed of several smaller lesions. The conglomerate mass measures 7.6 x 6.4 cm. The lesion involves segments 5, 6, and 7 and portion of the lesion also extends into the inferior margin of segment 8. There is a small satellite subcentimeter lesion in segment 8.The lesion does not show arterial enhancement greater than background liver. It shows slightly delayed enhancement. There is enhancing tumor thrombus within the anterior branch of the right portal vein with extension to the portal venous bifurcation. The lesion also causes obstruction of the right hepatic intrahepatic duct about the level of the portal venous bifurcation causing mild right intrahepatic biliary ductal dilatation. The left hepatic duct and common hepatic ducts are normal in caliber.Biliary sludge in the gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small left renal cyst. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: There are small portacaval lymph nodes. Malignant involvement is possible.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 7/6/2016 07:00:00)RIGHT HEPATIC LESION: 7.6 x 6.4 cm (Image -1, Series 8).
1.Dominant right hepatic lobe lesion with invasion into the right anterior branch of the portal vein with tumor thrombus extending almost up to the level of the portal venous bifurcation.2.Compression of the right intrahepatic biliary tree due to tumor. Causing mild intrahepatic biliary ductal dictation on the right.3.The imaging features of the lesion suggests a poorly differentiated carcinoma or cholangiocarcinoma. It does not have the expected arterial enhancement of a conventional HCC. An atypical HCC which is poorly differentiated or a cholangiohepatoma are possible.4.Intrahepatic metastases with satellite lesion in the superior aspect of segment 7.