67-year-old female patient with history of HCC and cirrhosis. Patient is called back for TACE/RFA. Note that examination is limited, as only postcontrast sequences were obtained.ABDOMEN:LIVER, BILIARY TRACT: Stable ablation cavities in the right inferior hepatic lobe and segment five.In the area of concern on the previous examination that is peripheral and superior to the initial ablation cavity in segment five, there is an ill-defined area of increased T2 and DWI signal intensity. This area demonstrates arterial enhancement and central washout in a serpiginous morphology (series 5 image 153). Additionally, there appears to be contrast going around the thrombus proximally on portal venous phase images, favoring portal vein etiology as opposed to biliary.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Area peripheral and superior to the initial ablation cavity in segment five demonstrates arterial enhancement with serpiginous washout. These findings are most compatible with recurrent tumor thrombus in the right anterior portal vein.