57-year-old female with history of HCC, cirrhosis, portal venous thrombosis, now status post TACE/RFA. ABDOMEN:LIVER, BILIARY TRACT: Nodular cirrhotic morphology of the liver, with diffuse low T2 signal compatible with hemosiderin deposition. Hazy increased T2 signal about the hepatic hilum is compatible with reticular fibrosis.There is an approximately 2.2 x 2.2 cm centrally low T1/T2 signal, peripherally high T1 signal lesion in the dome the liver, in the region of prior RFA ablation. No associated abnormal enhancement is seen to suggest recurrent/residual tumor. Although the arterial phase suboptimal, no new arterially enhancing lesions are evident.There is persistent luminal attenuation of the portal vein just distal to the confluence of the SMV and splenic vein, appearing similar to the prior examinations.The gallbladder is mildly distended and there is a large lamellated gallstone.SPLEEN: Enlarged spleen, measuring up to 16 cm in length. Perisplenic varices secondary to a splenorenal shunt are again identified, and appear roughly similar to the prior exam.PANCREAS: The pancreas appears slightly atrophic.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multifocal right renal parenchymal scarring again evident, unchanged. There is no hydronephrosisRETROPERITONEUM, LYMPH NODES: No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small right pericardial cyst unchanged. Small volume ascites.
1.Postprocedural changes compatible with prior RFA ablation of the right hepatic dome lesion, without evidence of residual or recurrent disease. 2.Suboptimal arterial phase, but no new arterially enhancing lesion seen to suggest new foci of hepatocellular carcinoma; however continued surveillance is recommended.3.Nodular cirrhosis with small volume ascites as well as sequelae of portal hypertension including perisplenic varices and splenomegaly.4.Persistent attenuation of the portal vein, which remains patent.5.Cholelithiasis and mild distention of the gallbladder, clinical correlation for chronic cholecystitis suggested.