59-year-old male with biopsy-proven multifocal HCC in right liver status post TACE/RFA in December 2014. Surveillance scan. LIVER, BILIARY TRACT: There is a 2.1 x 1.9 cm ablation cavity in the inferior right liver tip that does not demonstrate any residual internal or peripheral enhancement (series 10, image 122). Located more superiorly in the right liver, there is a second ablation cavity measuring 2.7 x 1.9 cm (series 10, image 132). Adjacent to this cavity, there is a nodular arterially enhancing lesion measuring 1.7 x 1.7 cm (series 10, image 52). This lesion also demonstrates some increased T2 and diffusion weighted signal with central washout on delayed phase images. Findings are suspicious for residual disease.The main portal vein is patent. No biliary ductal dilatation. Unchanged gallbladder wall thickening is likely reactive in the setting of cirrhosis. SPLEEN: Splenomegaly measuring 16.1 cm. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal or mesenteric adenopathy.BOWEL, MESENTERY: Small hiatal hernia, otherwise unremarkable.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace ascites. Nonspecific right lower lobe lung nodule. Extensive gastroesophageal varices.
1.Post-ablation changes in the right liver with nodular arterially enhancing lesion adjacent to the superior ablation cavity that demonstrates central washout. Findings are suspicious for residual HCC. 2.Cirrhotic liver morphology and findings compatible with portal hypertension as described above. 