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Case 43

Hepatoma and Portal Hypertension

Male, 60 yrs, right upper quadrant pain

This 60 year old man presented with vague right upper quadrant pain. He was a heavy drinker in the past but had no past medical history of note.

Findings

There is a large low attenuation lesion in segment 6 of the liver, which enhances poorly after contrast. This is visible on several images and is multifocal, and measuring over 5cm. Furthermore there are paraaortic lymph nodes present, suggesting metastatic spread. A further point of note is the presence of a dilated and enhancing umbilical vein running towards the umbilicus (the serpiginous structure anteriorly, adjacent to the gallbladder, arrowed on the above image), and a dilated vein is also seen in the subcutaneous tissues anterior to the liver.

Diagnosis

Inoperable hepatoma.
Portal hypertension with recanalisation of the umbilical vein and caput medusae.

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