Infiltrative hepatocellular carcinoma with tumor thrombosis
Background of cirrhosis due to viral hepatitis B, now referred with aggravated icterus, ascites and elevated alpha-fetoprotein about 50000 ng/ml
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A large heterogenous mildly hypo-enhancing area in all post-contrast phases is noted in the right liver lobe particularly the liver dome. Soft tissue with similar density to abnormal right liver lobe parenchyma is detected within the right portal vein lumen with neoangiogenesis in the arterial phase and minimal washout in the delayed phase.
Infiltrative and poorly differentiated HCC doesn't commonly semonstrate the typical arterial hyper-enhancement of well or moderately differentiated tumors. Tumoral thrombosis within the portal vein trunk or branches may be the only obvious imaging finding. The infiltrative tumor frequently is not visible as a discrete mass. Non-contrast images or DWI MRI may be useful.