Liver function test

HISTORY: 59-year-old female with right upper quadrant pain and elevated

liver function tests.

FINDINGS: Image 1 is a transverse scan of the right lobe of the liver

demonstrating diffuse heterogeneity and an ill-defined hypoechoic mass.

There is a small amount of perihepatic ascites.  Image 2 is another

transverse scan of the right lobe of the liver demonstrating an

echogenic tumor thrombus extending from the posterior division of the

right portal vein into the main portal vein.  Image 3 demonstrates to

better advantage the large echogenic tumor thrombus distending the

portal vein.

Image 4 is a color Doppler sonogram demonstrating vascularity with tumor

thrombosis is the portal vein.  Note the increased flow within the mass

on Image 5.

DIAGNOSIS: Hepatocellular carcinoma with portal venous invasion.

DISCUSSION: In the differential diagnosis of focal hepatic lesions

associated with portal vein invasion, hepatocellular carcinoma is by far

the most common entity.  Portal vein thrombosis may be due to either

tumor or bland thrombus.  Portal invasion is far more common in primary

hepatocellular carcinoma than with metastatic disease.  Not

infrequently, the tumor thrombus distends the vein and, with color

Doppler sonography or contrast CT, may show areas of intrinsic

vascularity or enhancement.  Hepatic venous invasion is also a typical

feature of hepatocellular carcinoma.  The primary tumor is sometimes

difficult to visualize with sonography due to its ill-defined margins.

This is true particularly in patients with diffuse underlying cirrhosis.

Other sonographic features of hepatocellular carcinoma include intrinsic

color Doppler vascularity, AV shunting along the periphery of the tumor,

and venous invasion of either the portal or hepatic veins.