Chronic hepatitis C. Alcoholic cirrhosis of the liver. ABDOMEN: LIVER, BILIARY TRACT: Nodular liver contour, caudate hypertrophy, and widening of the fissures are compatible with known cirrhosis. There is moderate hepatomegaly, measuring 22 cm in length. Numerous T1 hyperintense subcentimeter nodules are noted in both hepatic lobes, likely representing regenerative nodules.A central segment 8 lesion demonstrates arterial enhancement and washout on delayed phase imaging. The lesion measures 2.4 cm x 2.3 on arterial phase (series 12, image 33). Size on portal venous phase is not readily assessed given difficulty in separating tumor from peritumoral enhancement. On delayed images there is washout with capsule formation. The lesion including the capsule measures 3.0 by 2.6 cm on 3 minute post-contrast images (series 17, image 33). These findings meet criteria for hepatocellular carcinoma.A peripheral right hepatic lobe segment 5/8 lesion demonstrates early arterial enhancement and measures 1.1 x 1.1 cm (series 12, image 42), also showing washout on delayed phase (series 19, image 41). Findings meet criteria for hepatocellular carcinoma.There is an additional subtle segment 4 lesion adjacent to the gallbladder fossa demonstrating washout on delayed phase images. It measures 2.1 x 2.0 cm on 3 minute postcontrast images. No arterial enhancement is seen. These findings do not meet criteria but remain suspicious for hepatocellular carcinoma (4-5% of hepatocellular carcinomas are visible only on delayed images).A small, ill-defined arterially enhancing segment 8 lesion measures approximately 9 mm (series 12, image 50). No definite washout is observed. These findings do not meet criteria for hepatocellular carcinoma. Many lesions only demonstrating arterial enhancement are benign, but warrant attention on follow-up imaging.Other scattered T2 hyperintense lesions likely represent simple cysts.Sludge/stones noted in the gallbladder. Diffuse gallbladder wall edema, commonly seen in patients with chronic liver disease.Small volume upper abdominal ascites.SPLEEN: Mild splenomegaly is noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral simple cysts and other subcentimeter hyperintense lesions are noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Two hepatic lesions meet criteria for hepatocellular carcinoma. 2.A third segment 4 lesion demonstrates washout but no arterial enhancement. This does not meet criteria but remains highly suspicious for hepatocellular carcinoma (4-5% of hepatocellular carcinomas are visible only on delayed images).3.A fourth arterially enhancing segment 8 lesion is nonspecific though warrants attention on follow-up imaging.