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The coronal (A) and axial (B) view of chest contrast-enhanced computed tomography showing dextrocardia and SIT.
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Chest contrast-enhanced computed tomography showed that SIT (Figure 1A and B).
Computed tomography (CT) scans before stage I surgery. A giant mass (red arrow) measuring 7.1 x 5.5 x 5.6 cm in liver segments 8 was showed on CT scans. (A) plain scan; (B) arterial phase; (C) portal venous phase; (D) venous phase.
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The upper-abdominal enhanced computed tomography (CT) scan revealed one high-density areas (71 mm x 55 mm x 56 mm) in segment VII and VIII of the liver (Figure 2A-D), and magnetic resonance imaging presented a distinct liver tumor with about 7 cm in diameter in segment VII and VIII of liver (Figure 3A and B).
Magnetic resonance imaging showing a mass (red arrow) measuring 7.6 x 5.8 x 6.5 cm in segment VII and VIII of liver, (A) T1-weighted image; (B) T2-weighted image.
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The upper-abdominal enhanced computed tomography (CT) scan revealed one high-density areas (71 mm x 55 mm x 56 mm) in segment VII and VIII of the liver (Figure 2A-D), and magnetic resonance imaging presented a distinct liver tumor with about 7 cm in diameter in segment VII and VIII of liver (Figure 3A and B).
Intraoperative photographs during stage I surgery. (A) Selective isolation and ligation of the right portal vein (white arrow); (B) Ischemic line (white arrow) of the right liver.
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After full communication with the patient's family, it was decided to perform laparoscopic ligation of the right branch of the portal vein (Figure 4A and B).
Computed tomography (CT) scans images after course, the focus was smaller than before, the tumor activity was still seen, and there was a little effusion in the operative area (red arrow). (A) Plain scan; (B) Arterial phase; (C) Portal venous phase; (D) Venous phase.
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After another two courses of therapy, the follow-up contrast enhanced CT of upper-abdominal scan showed the size of liver lesions was continuous decrease and the lesions have homogeneous or heterogeneous density, most of this was necrotic (Figure 5A-D).  
Dynamic changes in tumor marker levels during treatment process. The decrease of des-gamma-carboxy prothrombin level reflects the reduction of tumor load. Alpha-fetoprotein was fair.
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The levels of tumor markers such as DCP and AFP were fair (Figure 6).
Computed tomography (CT) scans before stage II surgery. Reduce of tumor load (red arrow) was showed on CT scans. (A) plain scan; (B) arterial phase; (C) portal venous phase; (D) venous phase.
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CT scan revealed one heterogeneous density areas (35 mm x 31 mm x 44 mm) in segment VII and VIII of the liver (Figure 7A-D). Compared with the first upper-abdominal enhanced CT scan, the liver indicates liver cirrhosis, and the mass become more smaller, and the FLR volume was 71%, which meets the requirements of the surgery.
Magnetic resonance imaging showing a mass (red arrow) measuring 4.0x3.4 x 3.0 cm in segment VII and VIII of liver, (A) T1-weighted image; (B) T2-weighted image.
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Magnetic resonance imaging demonstrated that the tumor load was reduced (Figure 8A and B), and the second contrast-enhanced ultrasound (CEUS) showed the focal liver lesion was still classified as LI-RADS 5 lesion category according to The Liver Reporting and Data System (LI-RADS).
Intraoperative photographs during stage II surgery. (A) Ischemic line (white arrow) of the right live in stage I surgery; (B) Liver cross-section.
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At initial surgical exploration, ischemic line of the right live could be easily observed (Figure 9A). Mirror right hemihepatectomy was carried out until the diseased liver was totally removed (Figure 9B).
Surgical specimen and histopathological images. (A) The open resected specimen with liver tumor; (B and C) Pathological examination of tissue section; (B) 100 magnification; (C) 400 magnification.
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There was a large number of inflammatory cells infiltrating the surrounding liver tissue without definite evidence of tumor (Figure 10A-C).