Multifocal hepatocellular carcinoma with arterioportal fistula and portal vein thrombosis
Known patient with liver cirrhosis developed epigastric pain and abdominal enlargement
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Cirrhotic liver with multiple variable size enhancing focal lesions that display rapid washout in portovenous phase with associated thrombus of the right portal branch and confluence as well as arterio-portal shunt as evident by early filling of the right portal branches.
Diagnosis: Hepatocellular carcinoma (pathology proved)
Hepatocellular carcinoma may directly invade the portal vein branches and causes malignant thrombus and/or abnormal arterio-venous fistulous communication. Malignant thrombus usually shows the same enhancement criteria of HCC.