Hepatocellular carcinoma with arterioportal shunt
Abdominal pain in patient with hepatic focal lesion by ultrasound.
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A well-defined solid mass of the left lobe with exophytic growth. The mass demonstrates peripheral homogenous wash in of contrast on arterial phase with washout on venous and delayed phases. Abnormal filling of the left branch PV on the arterial phase of contrast administration may suggest possible arterioportal shunt. A small hypodense filling defect of the left branch PV may correspond to small thrombosis. Enlarged spleen. Recanalised periumbilical vein. Minimal right pleural effusion.
Intrahepatic arterioportal shunting in a case of hepatocellular carcinoma is not uncommon and is probably due to the abnormal connection between the arterial and venous supply of the tumor. On a triphasic study of the liver, the possible arterioportal shunt will demonstrate early filling of a portal vein branch with contrast material during the arterial phase, without the obvious filling of SMV, splenic vein or the main portal vein trunk.