Infiltrative hepatocellular carcinoma - tumor extension to the IVC and right atrium
Right upper quadrant pain.
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Established liver cirrhosis. The right lobe shows ill-defined heterogeneous mass lesion, initially hypodense with heterogeneous arterial enhancement and washout at delayed phases.
Portal vein thrombus at its division extending to both main portal branches partially filling their lumen.
Tumor thrombus is noted filling the right hepatic vein extending to the IVC till the right atrium. It shows enhancement at arterial phase with washout in the delayed phases.
Multiple porta hepatic lymph nodes, one of them showed calcification. Hepatic parenchymal calcifications are also noted.
Recanalized umbilical vein.
The diagnosis, in this case, is based on the imaging features and the clinical data only, however, it is hard to consider other differentials other than the HCC.