Male 59 years old Reason: 59 yo with HBV, cirrhosis, small lesion seen near spleen. Please followup ABDOMEN:LIVER, BILIARY TRACT: The liver is heterogenous with a nodular contour consistent with liver cirrhosis. No significant interval change in the previously described multiple nodules throughout the liver that demonstrate intrinsic T1 hyperintense signal, without arterial enhancement or corresponding T2 hyperintensity. These are most consistent with dysplastic nodules. None of these lesions meet strict criteria for an HCC. No intra or extrahepatic biliary duct dilatation. The portal vein is patent. No ascites.SPLEEN: No significant interval change in the reference enhancing lesion along the inferior margin of the spleen that measures 1.2 x 1.5 cm, previously 1.3 x 1.5 cm (series 904; image 144), which is nonspecific. This lesion at times appears isointense to the splenic parenchyma on postcontrast imaging, however, the lesion does not consistently match the spleen on every sequence and thus the appearance is not diagnostic for a splenule, there is also associated increased peripheral T2 signal abnormality on the fat saturated T2 weighted sequences. 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: No significant abnormality noted.
1. Stable reference lesion along the inferior margin of the spleen. Lesion remains indeterminate, may be an atypical splenule, a splenic hemangioma is also a differential consideration given the increased T2 signal abnormality. Further evaluation with a dedicated damaged RBC nuclear medicine scintigraphic examination with SPECT images may be considered for confirmation if clinically indicated. 2. Cirrhotic liver morphology with multiple lesions that are most consistent with dysplastic nodules. No lesion is identified that meets the strict criteria for an HCC however close surveillance is warranted. Patent hepatic vasculature.