Hepatomegaly and cirrhosis. Liver lesion on ultrasound and CT. History of HCV. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Mild intra and extrahepatic biliary ductal prominence is likely related to cholecystectomy state.The liver measures 18 cm in craniocaudal dimension.The segment 4 liver lesion is homogeneously intermediate signal intensity on T2-weighted images and measures approximately 3.8 x 3.0 x 4.9 cm (series 3/18). The lesion demonstrates a thick rind of peripheral enhancement and central heterogeneous enhancement. Small adjacent punctate arterial enhancing foci are noted (series 10/31).There is an additional rim-enhancing lesion in segment 7 of the liver (series 10/28) measuring 9 mm which fills in with contrast on delayed phase imaging.SPLEEN: The spleen is normal in size without a focal lesion.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: Small fat-containing umbilical hernia. OTHER: No significant abnormality noted.
The dominant segment 4 lesion measuring at least 3.8 x 3.0 cm is not compatible with a hemangioma. It does not meet imaging criteria for HCC. A cholangiocarcinoma is favored over an atypical HCC or metastases. Additional rim-enhancing lesion in segment 7 is suspicious for a satellite versus metastatic lesion. 