Presented with jaundice and abdominal pain with a background of known Hep B cirrhosis.
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Large heterogeneous arterial enhancing mass in the left hepatic lobe with portal venous phase washout. The mass is diffusely infiltrating the liver and there is evidence of both portal vein and IVC invasion by enhancing tumor thrombus. Tumor thrombus extends into the right atrium.
Background features of cirrhosis and portal hypertension, including ascites, porto-systemic varices, and splenomegaly. Cavernous transformation of the main portal vein likely reflects an element of chronic thrombus/occlusion in addition to the more recent tumor in vein.
This is a large, aggressive, diffusely-infiltrating hepatocellular carcinoma (HCC). It not only demonstrates portal vein invasion which is a common feature of HCC, but also IVC and right atrial invasion, which is not commonly seen.