Hepatoma with portal vein thrombosis

Case contributed by Subhan Iqbal
Diagnosis almost certain


Known case of hepatitis B, presented with right hypochondrial pain

Patient Data

Age: 90 years
Gender: Male

The liver is enlarged in size showing coarse cirrhotic heterogeneous echotexture. Multiple slightly hyperechoic lesions seen in both lobes of the liver, one of them measuring 63x57 mm in the right lobe. The portal vein is distended due to a long thrombus. It is showing vascularity on color doppler. Findings are suggestive of hepatomas with portal vein thrombosis.

Incidental note is made of mild ascites and benign renal cysts.

Annotated image

Portal vein thrombus.

Case Discussion

Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver. It is linked with cirrhosis, from both alcohol and viral reasons. HCC constitutes almost 5% of all cancers due to the high endemic rates of hepatitis B infection.

Portal vein thrombosis may be seen in a variety of clinical contexts, and when acute can be a life-threatening circumstance. It is a major cause of non-cirrhotic presinusoidal portal hypertension. Portal vein thrombus may be either bland and/or malignant i.e. tumor thrombus (as it in our case), and it is a critical finding in liver transplant candidates, as it precludes transplantation. Clinical manifestation is often vague and non-specific. If extensive acute thrombosis is existing, especially if the superior mesenteric venous system is also engaged, then the presentation is likely to be with acute ischemic bowel, mimicking superior mesenteric artery (SMA) occlusion.

Later on, patient undergoes a biopsy of the lesion, it was turn out to be hepatoma with tumor thrombus in the portal vein.

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