55-year-old female. Cirrhosis. Screen for HCC. ABDOMEN:LIVER, BILIARY TRACT: Liver contour: Nodular consistent with a cirrhotic morphologyFeatures of portal hypertension: Small esophageal and perigastric varices, ascites, and borderline splenomegaly. Portal vein: Patent proximal to the TIPS.Hepatic artery: PatentHepatic vein: Middle and left are patent. Right vein not well visualized due to artifact from TIPS.Lesions: 9 x 9 mm lesion (image 23, series 10; previously 9 x 8 mm) in the right hepatic dome, arterial enhancement - faint; washout - no; peripheral rim enhancement - no.Interval placement of TIPS, patency of which cannot be evaluated due to shunt artifact. New peripheral wedge-shaped arterially enhancing foci at the distal end of the TIPS in the hepatic dome with persistent contrast enhancement on delayed phases and no corresponding T2 signal abnormality, likely a perfusion abnormality.SPLEEN: Borderline splenomegaly measuring 12 cm. 1.8-cm distal splenic artery aneurysm (series 3, image 20), unchangedPANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Dilated retroperitoneal lymphatics, which may be due to cirrhosis and hypoalbuminemia, unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of abdominopelvic ascites. Small hiatal hernia with loculated pocket of fluid at the GE junction, unchanged.
1.Stable nonspecific right hepatic dome lesion with enhancement characteristics that do not meet strict criteria for HCC. No new worrisome lesion.2.Interval TIPS placement, patency of which cannot be evaluated due to shunt artifact. Small amount of ascites.3.1.8 cm distal splenic artery aneurysm, unchanged. Consultation with IR for possible embolization is suggested.