Multicenteric hepatocellular carcinoma in a cirrhotic liver
80 years old HCV positive patient with recently developed abdominal distension and markedly elevated alpha feto-protein.
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- Liver cirrhosis with heterogenous parenchyma and undulating outline. A hepatic dome subcapsular 4.5 X 3.5 cm exophytic mass lesion is seen with rapid heterogenous arterial enhancement as well as progressive wash out & capsular enhancement in the portal venous and delayed phases.
- A relatively larger ill-defined segment VI heterogenously enhancing mass is seen with rapid portal venous and delayed wash out.
- Innumerable small arterially enhancing lesions that get isodense in the portal-venous and delayed phases are seen.
- No intrahepatic or extrahepatic biliary tree dilatation.
- Portal hypertension, splenomegaly and marked ascites.
- Enlaged right cardiophrenic lymph node is seen measuring 4 X 3 cm with mild arterial enhancement as well as portal-venous washout.
- Small portahepatis lymphadenopathy.
- Two left renal middle and upper calyceal stones are seen with mild upper calyceal hydronephrotic changes.
- Normal right kidney (apart from a small upper polar 2 cm simple cortical cyst) and pancreas.
- Mild prostatomegaly.
- normal urinary bladder and seminal vesicles.
- Left oblique inguinal hernia and hydrocele.
- Mild left pleural effusion.
- Spondylodegenerative changes of the bony spine. No evidence of bony metastatic deposits.
- Liver cirrhosis with two malignant focal hepatic lesions; consistent with multicenteric hepatocellular carcinomas.
- Innumerable small arterially enhancing lesions that get isodense in the portal-venous and delayed phases are suggestive of regenerative or dysplastic nodules.
- Portal hypertension, splenomegaly and ascites.
- Enlaged right cardiophrenic lymph node; likley metastatic deposit.
- Small porta-hepatis lymphadenopathy.
- Karahan OI, Yikilmaz A, Isin S et-al. Characterization of hepatocellular carcinomas with triphasic CT and correlation with histopathologic findings. Acta Radiol. 2004;44 (6): 566-71. Pubmed citation