Hepatocellular carcinoma

Case contributed by Dr Mahomed A. Osman

Presentation

Hepatitis C. Worsening liver function tests and jaundice.

Patient Data

Age: Adult
CT

Large heterogenous soft tissue mass in the superior aspect of the right lobe of the liver, with a well circumscribed but irregular border. The mass shows heterogenous peripheral and central enhancement and contains a central area of hypoattenuation consistent with a necrotic core. There is early washout as the lesion is hypodense on portal venous phase imaging. Findings are consistent with focal hepatocellular carcinoma. Incidental left renal cyst.

There is no evidence of local metastasis. The portal and hepatic veins are spared.

Case Discussion

This lesion was proven HCC on biopsy. The portal and hepatic veins as well as the IVC and SVC should be looked at when HCC is suspected, in particular looking for direct tumour extension or thrombus. Interestingly in this patient, there appears to be heterogenous attenuation of the IVC but this is artefactual and is due to mixing of contrast coming in from the renal veins into the IVC. One can also see mass effect as the tumour compresses the proximal SVC.

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Case information

rID: 23929
Case created: 18th Jul 2013
Last edited: 9th Mar 2016
Inclusion in quiz mode: Included

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