Presentation
Abdominal mass.
Patient Data
Massive, heterogeneously arterially enhancing right hepatic lobe mass with areas of washout on the portal venous phase images. Notice the large internal artery coursing through the mass. Extension of tumor thrombus into the IVC and right atrium. Tumor thrombus in the left portal vein centrally. Cirrhosis, splenomegaly, small ascites.
Case Discussion
Very large, infiltrative hepatocellular carcinoma of the right hepatic lobe resulting in tumor thrombus in the central left portal vein, IVC and right atrium. When HCC gets this large not all of it will have the typical arterial hyperenhancement and washout because of the size and changes in perfusion. However the fact that there is tumor thrombus, underlying cirrhosis, and that it has a very robust arterial supply and smaller areas of the more typical arterial enhancement and washout are enough to confidently make the diagnosis. In this setting, I would not recommend biopsy.
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