Presentation
Elevated alpha-fetoprotein in a patient known for chronic hepatitis B. History of splenectomy following RTA. 35 years ago.
Patient Data
Dysmorphic liver with hypertrophy of the lateral segments of the left lobe (segments 2 and 3) and caudate lobe with concomitant atrophy of the posterior segments (5 and 6) of the right lobe.
Large well-defined ovoid mass of the right lobe of the liver centered on the segments (5, 6, 8). It elicits a low signal to the surrounding liver on T1, intermediate to high signal on T2 and T2 fat sat with intratumoral high signal on DWI. The postcontrast sequences demonstrate a vivid enhancement on the arterial phase, washout on the portal phase and peripheral rim enhancement on the delayed phase (capsule).
Calcified hydatid cyst of the segment 8 (known).
No splenic structure is seen (history of splenectomy).
Simple left renal cysts.
Case Discussion
The MRI features are most consistent with hepatocellular carcinoma (HCC) in a patient known for chronic hepatitis B with elevated alpha-fetoprotein.
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