Presentation
Epigastric pain and loss of appetite. Ultrasound shows multiple hepatic lesions for CT.
Patient Data
Cirrhotic liver configuration with peripheral and periportal ill-defined areas of hypoenhancement in venous phase with homogeneous enhancement in delayed phase. Lesions are radiating from porta hepatis to periphery. The peripheral areas show partial wedge shape with mild capsular retraction.
Multiple porta hepatis lymph nodes and a small left para-aortic lymph node.
Dilated common bile duct reaching 12 mm with no hyperdense stones identified. Minimal intrahepatic biliary radicals dilatation. Contracted gallbladder. Pancreatic duct is not dilated.
Scan through the lower chest revealed small paraesophageal hiatal hernia and cardiophrenic lymph node.
Case Discussion
Patient with liver cirrhosis with multiple geographic areas of decreased density and hypoenhancement in portal venous phase that homogeneously enhance in delayed phase associated with multifocal areas of capsular retraction. CT features are mostly representing confluent hepatic fibrosis, one of the rare hepatic pseudolesions. It should carefully be differentiated from malignant hepatic lesions which are also sequels of liver cirrhosis.
Differential diagnoses include cholangiocarcinoma, infiltrative hepatocellular carcinoma and hepatic metastases.
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