Multicentric Hepatocellular carcinoma with arterio-portal shunt

Case contributed by Dr Ahmed Abdrabou

Presentation

Known patient with liver cirrhosis and hepatocellular carcinoma on follow up.

Patient Data

Age: 55 years
Gender: Male

The liver displays typical cirrhotic features in form of hypertrophied left and caudate lobes, irregular outer border and widened fissures. Multiple ill defined variable size focal lesions are seen scattered at right and left hepatic lobes. Most of them appreciate enhancement in arterial phase followed by rapid washout in portovenous phase indicating multicentric hepatocellular carcinoma. A peripheral lesion is noted at left hepatic lobe doesn't follow that pattern and displays irregular nodular enhancement in arterial and portovenous phase which is believed to be hemangioma. 

Moreover, there is early enhancement of right and left branches of portal vein suggesting arterio-portal fistula, partial thrombosis of main PV and complete thromboiss of right branch PV. 

Case Discussion

PV thrombosis and arterio-portal shunt are two main complications of hepatocellular carcinoma. Unfortunately, the patient is not candidate for chemoembolization and was referred to the oncology clinic for palliative chemotherapy. 

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