Presentation
Liver lesions on USG; past history of viral hepatitis.
Patient Data
Well defined altered signal intensity lesion measuring approx. 114 x 91 x 107mm (AP x TD x CC) is seen in right lobe of liver, involving segments 5, 8 and compressing / possibly extending into segments 6, 7. Lesion shows early arterial enhancement with washout over portovenous, venous phases and persistent delayed peripheral capsular enhancement.
Distension with enhancement is also seen in right, left portal vein, extending into main portal vein.
Multiple heterogeneously enhancing, necrotic lesions (4 – 5 in number), ranging between 34 – 50mm in size are also seen in right lobe (segments 8 / 7).
Nodular, enhancing subcapsular lesion measuring approx. 10mm is seen in segment 5 of right lobe.
Multiple portosystemic collaterals are seen.
Spleen is enlarged, measuring approx. 145mm.
Case Discussion
Well defined altered signal intensity lesion in right lobe of liver, involving segments 5, 8 and compressing / possibly extending into segments 6, 7 is consistent with a hepatocellular carcinoma.
Distension with enhancement in right, left portal vein, extending into main portal vein, likely tumor thrombus.
Multiple heterogeneously enhancing, necrotic lesions (4 – 5 in number) in right lobe (segments 8 / 7) and nodular, enhancing subcapsular lesion in segment 5 of right lobe are likely metastases. Other possibility of multifocal hepatocellular carcinoma is also there.
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