Hepatocellular carcinoma with atrial invasion
Patient with HCC underwent chemoembolization and now for follow up
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A large heterogenous focal lesion involves the left lobe and anterior segment of right lobe and displays avid heterogenous enhancement in arterial and portovenous phases followed by washout in delayed phase. It extends to the IVC and the right atrium which appears exapnded by large faintly enhancing thrombus. Foci of lipidol concentration are noted.
Vascular invasion of hepatocellular carcinoma is a well recognized feature that usually involves the portal vein and to lesser extent hepatic veins and IVC. Thrombosis of the IVC and right atrium may be tumorous and non tumorous. Enhancement of the thrombus suggest its malignant nature. Tru-cut biopsy from the hepatic lesion reveals hepatocellular carcinoma.