Cirrhosis and ascites. Evaluate for tumor versus bland portal vein thrombus. Outside hospital biopsy revealing hepatocellular carcinoma. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with left and caudate lobe hypertrophy with a nodular contour.A discrete nodule adjacent to the IVC measures 3.4 x 3.1 cm and demonstrates faint arterial enhancement, washout and capsule formation compatible with hepatocellular carcinoma. Otherwise, the liver is diffusely heterogeneous. No additional discrete arterial enhancing lesion is seen on post contrast images however there are multiple discrete washing out lesions on portal venous and delayed phase imaging involving both the right and left hepatic lobe. Additional some of these lesions have faint T2 weighted hyperintensity, loss of signal on out-of-phase imaging and suggestion of capsule formation. There is a filling defect in the anterior division of the right portal vein. Although there is no vessel expansion or definite enhancement of the thrombus given the suspected extensive disease, tumor thrombus is nevertheless not entirely excluded.Trace perihepatic fluid.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Lobular right cardiophrenic lymph node measuring 1.3 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Cirrhosis with heterogeneous liver appearance. Suspected infiltrative HCC involving the right hepatic lobe and multiple satellite lesions in the left hepatic lobe given the degree of heterogeneity and several well-defined lesions seen on delayed phase imaging with associated faint T2-weighted hyperintensity, intracellular fat and suggestion of capsule formation - although not strictly meeting imaging criteria for HCC; multiple regenerative nodules is possible but less likely. There is a lesion adjacent to the IVC which meets imaging criteria for HCC. Correlate with site of and findings from patient's outside biopsy.2. Thrombus within the anterior division of the right portal vein. No vessel expansion or definite enhancement of the thrombus favors bland thrombus. In the setting of diffuse infiltrative HCC, tumor thrombus is not entirely excluded.