Hepatocellular carcinoma invading the portal vein.

HISTORY: Vague right upper quadrant pain with elevated liver function

tests.

 

FINDINGS: Images 1-6 are transverse and longitudinal scans of the liver.

Note there is a heterogeneity of the hepatic parenchymal echogenicity in

Images 1-4.  In Image 4 there appears to be a more discrete echogenic

mass within the liver that casts some refractive shadows.  Image 5 is a

sagittal scan of the main portal vein demonstrating diffuse level echoes

within the portal vein and distention of the walls of the vein.  Image 6

is a color Doppler sonogram demonstrating no flow within the portal vein

with a patent hepatic artery.

Images 7 and 8 are CT scans of the liver obtained with intravenous

contrast enhancement.  Notice the large infiltrating mass replacing much

of the right lobe of the liver, and in Image 8 an invasion of the main

portal vein.  Only the hepatic artery is visible in the porta hepatis.

DIAGNOSIS: Hepatocellular carcinoma invading the portal vein.

DISCUSSION: In patients with infiltrating neoplasms such as

hepatocellular carcinoma, CT can better delineate the extent of hepatic

parenchymal tumor.  On the other hand, color Doppler sonography is often

a very easy technique to confirm the presence of portal vein thrombosis.

In selected patients, arterial flow can actually be identified within

the viable tumor thrombus.