Diffuse hepatocellular carcinoma with portal vein thrombosis and arterioportal shunt

Case contributed by Dr Ahmed Abdrabou


Known patient of liver cirrhosis developed progressive abdominal pain and distension.

Patient Data

Age: 55 years
Gender: Female

The liver is cirrhotic showing irregular nodular outer border and hypertrophied left lobe. There is abnormal enhancement of the hepatic parenchyma, mainly the left lobe, in the arterial phase denoting diffuse malignant infiltration. Moreover, there is early enhancement of the left branch of portal vein suggestive of arterio-portal fistula and a large thrombus seen occupying the main portal and right branch of PV and the thrombus extends to the proximal part of the splenic and superior mesenteric veins as well. Nevertheless, multiple gastric fundal and splenorenal dilated portosystemic venous collaterals are seen. 

Other findings include mild perihepatic ascites, chronic calcular cholecystitis and two small left renal stones. 

Case Discussion

The typical enhancement criteria of hepatocellular carcinoma are enhancement in arterial phase followed by rapid washout in portovenous and delayed phases. This is owing to its tumoral angiogenesis. Two complications of HCC are seen in the current case including tumoral invasion of the portal vein and arterio-portal AV shunt.

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