Multifocal hepatocellular carcinoma
Chronic liver disease with rising AFP.
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Wavy nodular margins of liver with caudate lobe hypertrophy. Poorly defined infiltrative mass lesion is seen in right lobe of liver which shows arterial vascular recruitment, late arterial enhancement and equilibrium phase washout.
The left portal vein enhances and washes out similarly suggestive of tumor thrombus. The right and main portal vein shows complete bland thrombosis. Chronic partial thrombosis of superior mesenteric vein. The spleen is enlarged. Mild ascites.
Sometimes, hepatocellular carcinoma can have such infiltrative appearances with poor zone of transition with parenchyma that it is difficult to measure the exact size of the lesion. This is one such case where in the tumor is aggressive, highly infiltrative in right lobe and has moved to involve the left portal vein before it spreads into the left lobe.