Male 63 years old Reason: eval cirrhosis and for ascites History: AMS, hx of NASH cirrhosis LIVER: Background liver parenchyma is hyperechogenic compatible with history of cirrhosis, with corresponding morphology. There is a 1.7 x 1.4 x 2.6 cm hypoechoic mass in the right hepatic lobe. In the setting of a cirrhotic liver, this is concerning for HCC. Although the main portal vein appears patent with hepatopedal flow, there is decreased Doppler velocity, and much of the lumen is not opacified with color Doppler. Therefore partial thrombosis cannot be entirely excluded on this exam. Portal vein branches are patent with appropriate flow direction.BILIARY TRACT: Minimally thickened gallbladder wall, which is may be seen in the setting of cirrhosis. Common bile duct measures 4 mm. No intrahepatic biliary ductal dilatation.PANCREAS: The visualized portions of the pancreas are within normal limits.SPLEEN: The spleen is enlarged measuring 15.8 cm. There are perisplenic and splenorenal varices present.KIDNEYS: Right kidney measures 10.3 cm. Left kidney measurement is limited by bowel gas. No shadowing calculi or hydronephrosis.OTHER: No significant abnormalities noted.
1.Hypoechoic lesion in a cirrhotic liver suspicious for HCC. Recommend dedicated cross-sectional liver imaging for further evaluation.2.Partial thrombus of the main portal vein cannot be excluded as there is decreased Doppler flow.3.Sequela of portal hypertension including splenomegaly and varices are present.