Liver function tests

HISTORY: Rising liver function tests in a patient with known cirrhosis.

FINDINGS: Images 1-3 are transverse scans of the right lobe of the liver

demonstrating a focal hepatic mass of mixed echogenicity.  Portions of the mass are echogenic and other areas are hypoechoic.  Notice on Images 1 and 2 slight enhanced through-sound transmission deep to the mass.

There is also subtle, but clearly evident refractive shadowing (edge shadowing) on Image 1.  Image 3 is a high-resolution linear array color Doppler sonogram demonstrating little intrinsic vascularity within the

lesion.

DIAGNOSIS: Hepatocellular carcinoma.

DISCUSSION: Hepatocellular carcinoma has a variety of pathologic and

imaging features.  Different pathologic forms include conglomerate mass,diffusely infiltrating, multinodular, and multicentric.  Hepatic venous and portal venous invasion is a typical feature of hepatocellular carcinoma as well as AV shunting and rupture of the liver capsule.  This patient had few symptoms related to the lesion because of its small size.  However, patients may present with focal pain due to distention of the liver capsule and/or actual intraperitoneal rupture.  The imaging features are non-specific and relate to the pathologic form of hepatocellular carcinoma.  In selected patients, a peripheral capsule may be identified on MR imaging but is rarely appreciated with sonography.