An irregular segment 2 lesion measuring 39 x 71 x 25 mm demonstrates T2 hyperintensity, arterial phase enhancement portal and portal phase washout. The lesion invades and expands the left hepatic vein and origin of the middle hepatic vein. It extends into the IVC upto the right atrium. The middle hepatic vein poorly enhances. Differential liver parenchymal enhancement of segments 6/7 likely secondary to hepatic vein occlusion. There is a more well defined peripherally septated peripherally enhancing component more anteriorly measures 27 x 35 mm. The appearances are consistent with hepatocellular carcinoma. Multiple enlarged porta hepatis, gastroepiploic and coeliac lymph nodes identified. New left 22mm heterogeneously enhancing left adrenal lesion is consistent with metastasis. The biliary system is within normal limits. The common bile duct measures 2.8mm in diameter. No choledocholithiasis. Small volume free perihepatic fluid.
Conclusion: Segment II lesion as described with features consistent with aggressive, rapidly progressive HCC. There is extension of tumour into the left hepatic vein and common channel with the middle hepatic vein, IVC up to the junction with the right atrium. There is bland thrombosis of the distal portion of the middle hepatic vein. Multiple involved locoregional lymph nodes and new left adrenal lesion consistent with metastasis. Probable second HCC within segment 7 as described.