Hepatocellular carcinoma with metastatic porta-hepatis lymphadenopathy and IHBR dilatation

Case contributed by Dr Mohammad A. ElBeialy

Presentation

Cirrhotic patient with jaundice and abdominal distension.

Patient Data

Age: 65 years
Gender: Male

Ultrasongraphy revealed:

  • Liver cirrhosis, portal hypertension and ascites.
  • A right liver lobe segment V well-defined hypoechoic lesion.
  • Enlarged porta-hepatis and peri-pancreatic lymphadenopathy with dilated intrahepatic biliary radicles.

 

  • Cirrhotic configuration of the liver with irregular outline, heterogeneous parenchyma and hypertrophied left and caudate lobes.
  • A right lobe segment V mild arterially enhancing hypervascular lesion is seen measuring 4 X 3.5 cm. The lesion shows washout in the portal and delayed venous phases with capsular enhancement. The lesion shows heterogenous predominantly hypointense T1 signal with foci of hyperintensity that show signal drop-out in the axial GRE out of phase images indicative of fatty metamorphic changes. It shows T2 mild hyperintensity with a small central T2 bright focus within (nodule within nodule appearance).
  • Enlarged porta-hepatis and peri-operative lymph nodes are seen with the largest is 5 X 4 cm seen abutting the pancreatic head. The enlarged porta hepatis lymph nodes show evident restricted diffusion.
  • Moderate dilatation of the intra-hepatic biliary radicles.
  • Normal pancreas and both kidneys.
  • The spleen is surgically removed. 
  • Mild ascites.
  • Umbilical hernia containing small bowel loops and mesenteric fat.

Case Discussion

This case shows typical hepatocellular carcinoma (HCC) on top of cirrhotic liver with porta-hepatis and peri-pancreatic lymphadenopathy as well as dilatation of the intra-hepatic biliary radicles and ascites.

Hyperintensity on both T2- and diffusion-weighted images is helpful in the diagnosis of hypervascular HCC. Fat-containing hypervascular liver lesions that are hypointense on in-phase with further signal drop out in the out-of-phase sequence (chemical shift artefact) are strongly associated with the diagnosis of HCC.

Delayed hypointensity and enhancing rim improve the specificity of diagnosis of small HCC.

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Case information

rID: 35511
Case created: 8th Apr 2015
Last edited: 16th Dec 2015
Inclusion in quiz mode: Included

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