History of hepatitis C. Evaluate for HCC. LIVER: The liver measures 14 cm in length. The hepatic parenchyma is mildly coarse, but normal in morphology. The previously seen simple cyst was not identified on today's study. In the right hepatic dome there is a nonspecific 6 mm mildly echogenic lesion not seen on the prior study. Normal hepatopedal portal venous blood flow at 23 cm/s. BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation with the common duct measuring 3 mm. Normally distended gallbladder without wall thickening, gallstones pericholecystic fluid or focal tenderness. Nonmobile nodular focus measuring 5 x 4 x 5 mm; probable gallbladder polyp, unchanged.PANCREAS: The pancreas is obscured by overlying bowel gas shadowing and the patient's body habitus.SPLEEN: The spleen measures 9 cm in length without a focal lesion.RIGHT KIDNEY: The right kidney measures 11.5 cm with a superior pole 8.6 x 7.2 x 7.7 cm simple appearing cyst. No shadowing nephrolithiasis or hydronephrosis. OTHER: The left kidney measures 11.3 cm in length without shadowing nephrolithiasis, hydronephrosis or suspicious lesion.
Nonspecific 6 mm right hepatic dome mildly echogenic lesion statistically favors a hemangioma. However, given the history of HCV with no specific evidence of cirrhosis, attention to this lesion on surveillance imaging is recommended. If there is clinical concern an MRI may be of utility, although the lesion may be too small to characterize at this time. 