Hepatocellular carcinoma

Case contributed by Dr Heba Abdelmonem

Presentation

Abdominal pain and jaundice in patient with known hepatitis C virus.

Patient Data

Age: 65 years
Gender: Male
CT

Quad phase liver CT: 

  • non-contrast phase:
    • cirrhotic liver
    • splenomegaly
    • hypodense right liver lobe mass
  • arterial phase:
    • large, well-defined right lobe mass with heterogenous hyperenhancement and areas of necrosis
  • venous phase:
    • enlarged IVC with hypodense filling defect of its intrahepatic as well as suprahepatic portions keeping with IVC thrombosis
    • right branch of portal vein is dilated and completely filled with hypodense thrombus (enhancing, tumor thrombus)
    • patent lumen of left branch and main trunk portal vein as well as SMV
    • recanalized paraumbilical vein with portosystemic collaterals
  • delayed phase shows relative hypoenhancement of the mass (wash out)

Mild abdominal ascites is noted.

Case Discussion

65 year old patient, who was known to have hepatitis C virus, presented with abdominal pain and jaundice. Routine ultrasound detected a right hepatic lobe mass with thrombosed right portal vein branch. Laboratory findings of the patient included high alpha-fetoprotein levels, in keeping with hepatocellular carcinoma.

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