Hepatitis C. Worsening liver function tests and jaundice.
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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.
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 tumor 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 tumor compresses the proximal SVC.