Presentation
Focal hepatic lesions in a cirrhotic liver detected by ultrasonography for triphasic liver CT assessment.
Patient Data
Hepatic cirrhotic changes with distended distal portal vein and its branches (more on the right side), showing arterial hyperenhancement with delayed washout as well as diffusion restriction on DWI/ADC. This is associated with an altered signal with arterial hyperenhancement of most of the right lobe segments and IVA.
Manifestation of portion hypertension:
- moderate splenomegaly. No focal lesions
- mild ascites
- gastro-esophageal and perisplenic collaterals
Calcular gall bladder disease with multiple small (averaging 2mm) signal void intraluminal stones. No intrahepatic or extrahepatic biliary dilatation observed.
Atrophic right kidney with pelvicalyceal dilatation. Left simple renal cysts (1.8 cm the largest). Normal MRI features of the visualized portions of the left kidney.
Case Discussion
Chronic HCV patient with established cirrhotic liver, currently complicated by infiltrative hepatocellular carcinoma (HCC) with portal vein invasion forming tumor thrombus (LR-TIV).
Portal vein thrombus is considered a tumor thrombus, as it shows enhancement on arterial phase, vessel expansion and the indistinction between the thrombus and the tumor itself. Macrovascular invasion is characteristic of HCC with the involvement of the portal vein more common than the hepatic veins.