History of hepatocellular carcinoma status post TACE/RFA. History of HBV cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: The left hepatic lobe ablation cavity measures 1.9 x 1.4 cm (series 8/228), unchanged. Adjacent to the dorsal aspect of this ablation cavity is a 2.7 x 2.8 cm poorly enhancing mass with associated intermediate T2 weighted signal hyperintensity and restricted diffusion, not definitively seen on the prior study. There is associated poorly enhancing suspected tumor thrombus in the left portal vein and possible involvement of the bile duct.Right hepatic lobe superior peripheral ablation cavity measures 2.8 x 1.8 cm (series 8/222), compared to 2.6 x 1.8 cm previously containing proteinaceous/hemorrhagic debris, unchanged.The right hepatic lobe inferior peripheral ablation cavity measures approximately 2.8 x 1.4 cm (series 8/226), compared to 3.4 x 1.9 cm previously containing proteinaceous/hemorrhagic debris.The more medial right hepatic lobe ablation cavity measures 2.8 x 1.3 cm (series 8/226), compared to 2.5 x 1.8 cm previously, not significantly changed.Stable punctate hypervascular lesion in the left lateral segment of liver compatible with a portal to hepatic venous shunt. The right and main portal vein is patent. The visualized hepatic artery is patent. No stigmata of portal hypertension.Cirrhotic liver morphology including hypertrophy of the left hepatic and caudate lobes. Significant atrophy of the right hepatic lobe. Status post cholecystectomy.Demonstrated again is common bile duct dilatation up to 13 mm which tapers smoothly to the level of the ampulla, unchanged and likely related to age and postcholecystectomy state. No filling defect to suggest a mass or stone. The cystic duct remnant is noted.SPLEEN: No significant abnormality noted.PANCREAS: Stable 4 mm pancreatic head sidebranch IPMN.ADRENAL GLANDS: Punctate renal cysts are noted bilaterally, unchanged.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable nonspecific mild elevation of the left hemidiaphragm.OTHER: No significant abnormality noted.
1.New 2.8 cm segment 3 lesion just dorsal to the left hepatic lobe ablation cavity demonstrating poor enhancement and suspected tumor thrombus of the left portal vein. This does not meet imaging criteria for hepatocellular carcinoma. Differential considerations include atypical hepatocellular carcinoma, cholangiocarcinoma and cholangiohepatoma.2.Stable postablation changes of the right hepatic lobe without evidence of marginal recurrence.