Case 99:   Hepatocellular Carcinoma (HCC)

Diagnostic Category:

Clinical Presentation:

70 year old man presents with abdominal pain and jaundice.

CT: Multicentric HCC with vascular invasion of portal, hepatic veins, IVC and right atrium

Imaging Findings:

Multiphase CT reveals multicentric HCC, with typical arterial hypervascularity, delayed washout, and invasion of the main portal vein, portal branches, right hepatic vein, IVC and right atrium. Note the tumor thrombus demonstrates hypervascularity and washout (thread and streak sign).  The right lobe demonstrates arterial phase hypervascularity as an arterial buffer response to occlusion of the right portal vein.  Alpha-fetoprotein level was markedly elevated at 1522 ng/dL Biopsy was deferred.