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Multifocal hepatocellular carcinoma with arterioportal fistula and portal vein thrombosis

Case contributed by Ahmed Abdrabou
Diagnosis certain

Presentation

Known patient with liver cirrhosis developed epigastric pain and abdominal enlargement

Patient Data

Age: 50 years
Gender: Male

Cirrhotic liver with multiple variable size enhancing focal lesions that display rapid washout in portovenous phase with associated thrombus of the right portal branch and confluence as well as arterio-portal shunt as evident by early filling of the right portal branches.

Diagnosis: Hepatocellular carcinoma (pathology proved)

Case Discussion

Hepatocellular carcinoma may directly invade the portal vein branches and causes malignant thrombus and/or abnormal arterio-venous fistulous communication. Malignant thrombus usually shows the same enhancement criteria of HCC.

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