The liver is mildly enlarged in size, showing cirrhotic features in the form of a serrated outline with multiple small dysplastic nodules scattered in the liver parenchyma. Multiple focal lesions seen in multiple segments mainly at IV, V, and VI, the largest is seen at segment IVb/V measuring about 6.0 x 5.0 cm. These masses display intermediate signal intensity in T2WI, hypointense signal in T1WI and show early enhancement followed by washout. There is evidence of restricted diffusion.
One of the lesions is seen inseparable from the anterior branch of the right portal vein which shows marginal enhancement and central washout with a lack of normal enhancement pattern, denoting malignant thrombosis.
The portal vein is dilated measuring about 1.8 cm. The spleen is enlarged with dilated portosystemic collaterals suggestive of portal hypertension.
No ascites or peritoneal deposits. No pathologically significantly enlarged periaortic lymphadenopathy seen.
Impression:
Findings mentioned above impressive of multifocal hepatocellular carcinoma with malignant thrombus at the anterior branch of the right portal vein.
Features of portal hypertension.