65-year-old male patient with history of HCC status post intraop RFA. Assess liver lesions. ABDOMEN:LIVER, BILIARY TRACT: The liver is cirrhotic in morphology.Post-ablation cavity in segment 6 measuring approximately 3.9 x 1.7 cm (22, series 1002). There is interval enlargement and heterogeneity of an arterially enhancing, diffusion restricting nodular marginal lesion along the medial aspect of the ablation cavity now measuring 2.6 x 2.5 cm (image 27, series 1001), previously 1.5 x 1.4 cm. An anterior component of this lesion washes out on delayed imaging; this is consistent with residual and/or recurrent hepatocellular carcinoma.Post-ablation cavity in segment 5 measuring approximately 3.6 x 2.2 cm (image 30, series 1002). There is interval enlargement of a marginal nodular area of arterial enhancement with restricted diffusion along the anterior aspect of the ablation cavity measuring approximately 2.5 x 1.5 cm (image 33, series 1001). This lesion washes out on delayed imaging and is consistent with residual and/or recurrent hepatocellular carcinoma.Post-ablation cavity in segment 3 measuring approximately 2.1 x 0.8 cm (image 33, series 1002) without evidence of marginal recurrent/residual disease. A subcentimeter arterially enhancing focus in segment 9 is again noted and does not wash out on delayed imaging; this may be perfusional in etiology (image 23, series 1001). Additional, scattered T2 hyperintense foci are compatible with cysts. There is new vague T2 hyperintensity within the inferior right hepatic lobe with corresponding new restricted diffusion. Within this region, there is also geographic non-enhancement of the liver parenchyma measuring up to 8.5 x 6.7 cm. Furthermore, the posterior branch of the right portal vein is no longer visualized and likely thrombosed secondary to the adjacent hepatic 6 lesion. The hepatic veins are patent. The left and main portal veins are patent otherwise. SPLEEN: Splenomegaly with the spleen measuring 20 cm in the craniocaudal dimension with scattered presumed siderotic nodules. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Splenorenal shunt.RETROPERITONEUM, LYMPH NODES: Periportal lymph nodes are again noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable vertebral body enhancing focus (image 41, series 1003).OTHER: No significant abnormality noted.
1.Two enlarging areas of marginal nodular enhancement about the hepatic segment 5 and 7/6 ablation cavities is consistent with residual and/or recurrent tumor foci. 2.Interval occlusion of the posterior branch of the right portal vein, likely secondary to adjacent hepatic segment 7/6 lesion, with a geographic area of non-enhancement within the inferior right hepatic lobe favored to represent related vascular insult.