Hepatocellular carcinoma better depicted with contrast CT than with ultrasound.

HISTORY: Right upper quadrant pain and elevated liver function tests.

 

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

demonstrating marked heterogeneity of the hepatic parenchymal

echogenicity.  Subtle refractive shadowing is noted in Image 1.  In

Image 2 there is evidence of a vague echogenic mass seen centrally in

the right lobe of the liver.

Images 4-6 are contrast-enhanced CTs demonstrating cirrhosis with a

nodular liver contour.  There is perihepatic ascites and a large right

lobe liver mass.  On Image 5 there is evidence of portal venous

invasion.

DIAGNOSIS: Hepatocellular carcinoma better depicted with contrast CT

than with ultrasound.

DISCUSSION: In patients with advanced cirrhosis, the sonographic

diagnosis of hepatocellular carcinoma may be quite challenging.  Fatty

infiltration, regenerative nodules, and confluent fibrosis all degrade

the sonographic evaluation of the liver.  Nevertheless, refractive

shadows are very worrisome for a space occupying mass as evident in

Image 1 of this case.  CT more clearly depicted the parenchymal mass and

clearly demonstrated the portal venous invasion to better advantage.