Reason: liver mass, pathology unclear as to HCC vs cholangio (mixed), old MRI poor quality from outside 4/2016 that is uploaded, evaluate for satellite lesions and portal lymphadenopathy (ie resectability) History: none ABDOMEN:LIVER, BILIARY TRACT: There is hypertrophy of the caudate and left hepatic lobe with deepening of the fissures, suggestive of chronic liver disease.There is a lesion in segment 5 which appears increased since the prior exam and measures 4.6 x 4.8 cm (801/54). This lesion is slightly hyperenhancing on arterial phase images and demonstrates washout on delayed phases, a pattern suggestive of hepatocellular carcinoma. This lesion was present on the prior MRI, however no corresponding dominant lesion is identified on the CT of 11/24/2015.A previously biopsied hypoenhancing segment 4A lesion measures 4.7 x 3.3 cm (801/73), unchanged. This lesion is hypoenhancing on all phases with increased capsular retraction.There is an additional adjacent hypoenhancing segment 4A lesion in the hepatic dome (11/16) with diffusion restriction, similar in size to the prior MRI.There are numerous additional hypoenhancing T2 hyperintense lesions throughout both hepatic lobes which are suspected to represent metastases. These lesions are slightly less apparent than the prior MRI. These lesions correspond to hypodense lesions on the CT from 11/24/2015SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral perinephric stranding is unchanged.RETROPERITONEUM, LYMPH NODES: Enlarged portacaval node measuring 3.0 x 1.6 cm (14/23).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Median sternotomy wires.
1.A biopsied segment 4A lesion is unchanged in size with capsular retraction. An additional dominant segment 5 lesion is slightly increased in size. There are findings suggesting chronic liver disease and in this setting, this lesion demonstrates enhancement on arterial phase and washout, suggestive of hepatocellular carcinoma or a hepatocellular carcinoma variant such as a cholangiohepatoma. Although there is capsular retraction of the segment 4A lesion, the enhancement pattern is not consistent with cholangiocarcinoma.2.Numerous hypoenhancing lesions in both hepatic lobes are suspected to represent metastasis. These are slightly less apparent than the prior MRI, which could be due to differences in technique. These lesions correspond to hypodensities on the CT of 11/24/2015.3.Enlarged portacaval lymph nodes.