Presentation
Known liver cirrhosis presenting with systemic symptoms and mild jaundice with labs showing elevated bilirubin, decreased albumin levels and elevated alpha fetoprotein (1480 ng/mL).
Patient Data
Cirrhotic liver with its parenchyma studded by multiple innumerable scattered focal lesions and nodules are seen varying in size from 1-2 mm to 3.2 cm in size with the largest in hepatic segment VI. They show intense enhancement at the arterial/portal phases with washout of contrast in the delayed phase. 3 x 2.4 cm pathologically-enlarged lymph node is seen inferoposterior to the pancreatic head showing a similar enhancement pattern to the hepatic lesions measuring .
Marked ascites.
Horseshoe kidneys showing no back pressure changes or masses.
Case Discussion
Multiple bilobar hepatic focal lesions and nodules with enhancement pattern pathognomonic of diffuse cirrhotomimetic-type HCC. This was supported by the marked elevated levels of alpha fetoprotein.
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