Metastatic hepatocellular carcinoma with tumor thrombus

Case contributed by Mostafa Elfeky
Diagnosis almost certain


Chronic hepatitis C patient currently presented with jaundice, deranged liver functions and abdominal pain.

Patient Data

Age: 50 years
Gender: Male

The liver shows established cirrhosis. It shows ill-defined infiltrative lesions replaces all the right lobe parenchyma, as well as multifocal small nodules in the left lobe, associated with diffusion restriction and faint enhancement and an enhancing thrombus expanding the right portal vein, reaching the main portal vein.

Scattered segments of intrahepatic biliary dilatation, by the effects of the infiltrative tumor.

Large porta hepatis metastatic node measures 5 cm.

Bilateral basal pulmonary nodules, reaching 2.5 cm, mostly lung metastases. 

Portal hypertension, shown as:

  • moderate splenomegaly, with no focal lesions
  • dilated gastro-esophageal and splenorenal collaterals
  • mesenteric congestion, and mild ascites

Case Discussion

This case shows sequels of chronic liver cirrhosis due to hepatitis C, with extensive infiltrative and multifocal hepatocellular carcinoma complicated by portal vein tumor thrombus (tumor-in-vein / macrovascular invasion) and metastatic porta hepatis lymph node as well as diffuse pulmonary metastases. They show post-contrast enhancement and diffusion restriction.

Features of tumor thrombus shown are:

  • direct continuity with the tumor
  • postcontrast enhancement and diffusion restriction as the tumor itself
  • expansion of the portal vein
  • isosignal to the tumor on T1WI and T2WI sequences

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