History of hepatocellular carcinoma status post TACE/RFA. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic nodular liver morphology. Normally distended gallbladder. No intra or extrahepatic biliary ductal dilatation. Large volume of perihepatic ascites.Interval segment 5 ablation with the ablation cavity measuring approximately 3.0 x 1.9 cm (series 10/43). Along the anteromedial and caudal aspect of the ablation cavity there is a 2.0 x 1.6 cm arterial enhancing lesion (series 9/46) which demonstrates subtle washout (series 10/44) compatible with residual tumor.In segment 7 of the liver there is a 1.3 x 1.0 cm lesion seen on 3 minute delayed phase imaging as a hypointense lesion with a subtle capsule (series 10/31). In retrospect it may have been present previously but is increased in size. No definite arterial enhancement.SPLEEN: The spleen measures 13.6 cm in craniocaudal dimension.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: Large volume ascites.BONES, SOFT TISSUES: Bilateral at least moderate size pleural effusions.OTHER: No significant abnormality noted.
1.Status post segment 5 ablation with a marginal 2.0 cm lesion with features meeting imaging criteria for HCC.2.Increased size of a segment 7 1.3 x 1.0 cm lesion which is hypointense on delayed phase imaging with a subtle capsule but no definite arterial enhancement. Although this does not meet HCC imaging criteria it is nevertheless highly suspicious for HCC (A small subset of HCC present with washout without arterial enhancement).3.Cirrhosis with stigmata of portal hypertension including mild splenomegaly and large volume ascites.