63-year-old male with hepatic encephalopathy, right liver lesion. Triple phase MRI abdomen to evaluate right hepatic lesion. Also evaluate for possible portal vein thrombus is possible. Exam limitations related to extensive respiratory motion artifact.ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology. In hepatic segment 4A, there is a 2.1 x 2.6 cm T1 hypointense, T2 hyperintense focus demonstrating restricted diffusion (series 10 image 40, series 7 image 13, series 8 image 98). On the postcontrast series, this lesion is isointense to the remaining parenchyma and shows no definite washout. The splenic vein and splenic/SMV confluence are patent. There is marked attenuation of the main portal vein and intrahepatic portal veins with a size discrepancy at the portal confluence. There is intraluminal thrombus at the origin of the main portal vein (series 11 image 272).Few small scattered hepatic cysts. Normally distended gallbladder with nonspecific wall thickening, which could be related to the chronic liver disease. SPLEEN: Splenomegaly measuring 14.5 cm in length. Splenic varices and a splenorenal shunt are noted.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 supraumbilical ventral hernia (series 1 image 13).OTHER: No significant abnormality noted.
1.In hepatic segment 4A, there is a 2.1 x 2.6 cm lesion demonstrating restricted diffusion. Although no arterial enhancement or washout is seen, this lesion remains suspicious for HCC.2.Marked attenuation of the main and intrahepatic portal veins with size discrepancy at the portal confluence where small intraluminal thrombus is seen. Chronic thrombus is favored.3.Cirrhotic morphology with sequelae of portal hypertension including splenomegaly and collateral varices.