History of hepatocellular carcinoma status post TACE/RFA. ABDOMEN:LIVER, BILIARY TRACT: Liver is cirrhotic in morphology with atrophy of the right lobe, widening of the intrahepatic fissures, and surface nodularity. Recanalized umbilical vein and other portosystemic collaterals indicate portal hypertension.Within hepatic segment 8, anterior to the right hepatic vein the previously described arterially enhancing lesion with washout has been replaced by an ablation cavity which measures 12 x 20 mm (series 904, image 194). There is equivocal thin rim enhancement surrounding the ablation cavity which may be a posttreatment change. Otherwise, the ablation cavity does not enhance. There is a new wedge-shaped area of arterial enhancement in the periportal aspect of segment 8 (series 901, image 252) which does not washout and may represent a posttreatment transient hepatic intensity difference. No new suspicious arterial enhancing lesions are identified in the liver.There is cholelithiasis and mild gallbladder wall thickening which is nonspecific in the setting of chronic liver disease appearing similar to prior. No intra or extrahepatic biliary ductal dilatation.SPLEEN: Moderate splenomegaly with spleen measuring up to 18.5 cm in the craniocaudal dimension. Perisplenic collaterals.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple renal cysts the largest of which arises from the inferior pole of the left kidney measuring up to 6.4 cm. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is a 1.7 x 3.4 cm focus of non mass-like enhancement within the left breast (series 901, image 412) which demonstrates T2 hyperintensity as well as restricted diffusion.OTHER: Trace amount of ascites is seen along the inferior aspect of the liver.
1.Interval ablation of segment 8 hepatocellular carcinoma without evidence of residual or recurrent disease. Continued follow-up is recommended.2.Cirrhosis with splenomegaly and portal hypertension and trace amount of ascites.3.Cholelithiasis with gallbladder wall thickening appearing similar to prior; in the absence of symptomatology suggesting acute gallbladder disease, gallbladder wall thickening is common in patients with cirrhosis and not indicative of acute disease.4.Findings suggestive of gynecomastia of the left breast; correlation with mammography can be considered as clinically warranted.