Umbilical vein recanalization identified on contrast-enhanced ultrasound in a patient with hepatocellular carcinoma during TACE assessment

This case report demonstrates the potential use of contrast-enhanced ultrasound as a support tool for vascular abnormality findings previously seen on cross-sectional imaging. We describe a 62-year-old woman with history of metabolic dysfunction-associated steatotic liver disease who presented abdominal pain. Ultrasound demonstrated cirrhosis and indeterminate liver lesions. With these findings, contrast-enhanced magnetic resonance imaging was performed and 2 LI-RADS 5 lesions < 3 cm and vascular changes consistent with portal hypertension were observed. Before transplant, the patient underwent transarterial-chemoembolization for bridging. Contrast-enhanced ultrasound was used to assess tumor vascularity pre- and post-TACE. During the post-TACE exam, the sonographer showed an immediate lack of intra-tumoral enhancement, but also observed a hyper-enhanced vessel, characteristic of umbilical vein recanalization previously seen on cross-sectional imaging. Contrast-enhanced ultrasound, used for characterization of focal liver lesions, can aid in the visualization of vascular changes during portal-hypertension due to its ability to visualize perfusion in real-time.