Atypical presentation of a locally advanced hepatocellular carcinoma: Extensive workup of an incidental finding on computed tomography performed for planning of transcatheter aortic valve implantation

Figures

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  Fig. 1. Incidental hepatocellular carcinoma (HCC) in a 72-year-old patient. Tumor thrombosis of the portal vein and altered tissue structure on CTA in axial (A) and coronal 4 mm reformation (B). Diagnosis of a diffusely growing primary liver tumor with portal vein thrombosis, subsequently confirmed upon biopsy.

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  Fig. 2. Ultrasound with B-mode indicating a diffusely altered echogenicity of the left liver lobe (A). Contrast-enhanced ultrasound (CEUS) images acquired in arterial phase (after 33 seconds, B) and late venous phase (after 3 min, C) show early arterial inflow in the left liver lobe (LL) compared to the right liver lobe (RL). Washout in the left lobe (asterisk) was only present in superficial area, while the dynamic examinations cannot differentiate real lesion washout from bubble destruction in the near field, as the left lobe showed inhomogeneous washout in the late contrast phase.

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  Fig. 3. MRI showed a T2 hyperintense left lobe (A) with early enhancement on arterial phase (B). Washout of the altered left liver lobe can be appreciated on portal venous and venous phase (C). The left liver lobe showed no hepatocyte uptake during the hepatobiliary phase (D).