Presentation
History of chronic alcoholism. Presents with abdominal distension and pain. Ultrasound shows chronic liver disease with ascites. AFP elevation on blood tests (166 ng/ml).
Patient Data
small, dysmorphic, and nodular-margined liver (there is a hypertrophy of the caudate lobe and advanced atrophy of the segments 2 and 3)
parenchymal heterogeneity in both pre and post-contrast
complete thrombosis of the posterior inferior segmental portal branch which demonstrates a soft tissue enhancement after contrast, in keeping with a tumoral thrombus
there is also an ill-defined heterogeneous hypervascular mass in the lower part of the segments 6, demonstrating a mild washout in the delayed phase. this lesion has no capsule nor clear fatty component.
obstructive intrahepatic bile duct dilatation is also seen in the segments 6 and 7
signs of portal hypertension including porto-systemic collateral pathways and splenomgealy
the gallbladder is unremarkable.
there is no common bile duct dilatation.
marked pancreatic atrophy. There is no dilattion of the main pancreatic duct.
ascites with no significant peritoneal enhancement
there is no abdominal lymphadenopathy
multidiverticular bladder with a focal hypevascular parietal thickening in the suerpior and lateral walls of the bladder.
left superior lingular solid mass measuring 29 mm in diameter. Two other lobulated masses in the lower right lobe.
ground glass opacities and thickening of the interlobular septa in the upper lobes associated with traction bronchiectasis in keeping with fibrosing interstitial lung disease
bilateral mild lung effusions
Case Discussion
Features of an infiltrative hepatocellular carcinoma with a tumor-in-vein (LI-RADS-TIV) and metastatic pulmonary nodules.
Associated fibrosing interstitial lung disease in the upper lobes and no signs of lymphangitis carcinomatosis.
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