Reason: history of autoimmune hepatitis, hepatocellular carcinoma presents with pancreatitis History: abdominal pain ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with numerous T1 hyperintense nodular foci, suspicious for regenerative nodules (although corresponding T2 hypointense signal difficult to appreciate). There is a T2 hyperintense, hyperenhancing lesion within segment 5/8 which demonstrates avid arterial enhancement and associated washout as well as restricted diffusion, compatible with hepatocellular carcinoma with reference measurements below. There are 2 additional smaller hyperenhancing lesions within segment 7 which do not demonstrate definite washout or restricted diffusion. There is a subcentimeter T2 hyperintense structure in the hepatic dome which lacks enhancement and may reflect a cyst.The hepatic veins are diminutive. The portal vein appears patent.Cholelithiasis. There is mild diffuse gallbladder wall edema which is nonspecific in the setting of ascites.There is mild narrowing of the common hepatic duct just distal to the confluence which may be related to adjacent vessel or hepatic nodule without associated significant upstream dilation. The common bile duct is normal in caliber measuring up to 5 mm. No evidence of choledocholithiasis.SPLEEN: Splenomegaly.PANCREAS: There is diffuse pancreatic edema and mild enlargement as well as mild restricted diffusion which is compatible with acute pancreatitis. The pancreatic parenchyma enhances homogeneously without evidence of pancreatic necrosis. No loculated peripancreatic fluid collections are identified.The pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis. There are several punctate foci of susceptibility artifact in the distribution of the renal sinuses suggestive of nephrolithiasis. The renal parenchyma enhances homogeneously.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild abdominal pelvic ascites.INDEX LESION MEASUREMENTS (Current exam date/time: 9/6/2016 18:10:26)SEGMENT 5/8 HEPATIC LESION: 3.9 x 2.6 cm (Image 133, Series 13).SEGMENT 7 HEPATIC LESION, MORE POSTERIOR: 1.8 x 1.1 cm (Image 116, Series 13).SEGMENT 7 HEPATIC LESION, MORE ANTERIOR: 1.0 x 0.7 cm (Image 113, Series 13).
1.Nodular cirrhotic liver with sequela of portal hypertension.2.Hyperenhancing lesion with washout in hepatic segment 5/8 compatible with hepatocellular carcinoma.3.Two additional hyperenhancing hepatic lesions in segment 7 which lack washout and do not currently fulfill criteria for hepatocellular carcinoma but should be followed closely on subsequent examinations.4.Cholelithiasis and diffuse gallbladder wall thickening which is nonspecific in setting of mild abdominopelvic ascites.5.No evidence of choledocholithiasis or pancreatic duct dilation. 