Presentation
Known cirrhosis and history of hepatocellular carcinoma lesions treated with percutaneous ablations.
Patient Data
Multiphase liver
Enhancing mass distending a proximal paraumbilical vein, which shows vivid arterial enhancement and washout on the delayed phase. Enhancement of other paraumbilical veins noted without tumor thrombus. It appears to also extend into the adjacent liver segment III. Cirrhotic liver with hypovascular scars in the right lobe related to previous ablation therapies. Bland thrombus in the portal, splenic, and superior mesenteric vein. Features of portal hypertension characterized by varices, splenomegaly, and ascites. Gallstones. Right-sided large pleural effusion.
Case Discussion
Typical imaging features of HCC invading and distending a paraumbilical vein. In this epidemiology, imaging is sufficient for the definitive diagnosis. Similar to portal vein tumor thrombus, the paraumbilical tumor thrombus is grouped together with metastatic hepatocellular carcinoma and, therefore, only palliative treatment is offered at this stage.
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