PMC3572312_01
(A) A contrast-enhanced computed tomography (CT) shows portal vein thrombosis (PVT) (black arrow) within the posterior segmental branch of the right portal vein. Focal capsular atrophy was seen in combination with PVT, and there was no enhancement in that area. (B) A T2-weighted image shows PVT (white arrow) with high signal intensity within the posterior segmental branch of the right portal vein. There was no parenchymal tumor surrounding the PVT. (C) A Gadolinium-enhanced T1-weighted image shows mild enhancing PVT (black arrow) with low signal intensity in the posterior segmental branch of the right portal vein. A wedge-shaped enhancement (black arrowheads) is shown in the posterior segment of the right hepatic lobe, which was the result of the secondary-enhanced parenchymal blood supplied by the right hepatic artery due to the decreased portal flow. (D) An ultrasound image shows hypoechoic PVT (white arrow) within the right portal vein of the cirrhotic liver. The 18-gauge cutting needle (white arrowhead) within the malignant PVT is shown during the percutaneous ultrasound-guided biopsy. (E) The needle biopsy sample showed a trabecular arrangement of tumor cells with abundant eosinophilic cytoplasm, suggestive of hepatocellular carcinoma (H&E stain, x100). (F) A follow-up preoperative contrast-enhanced CT image shows the increased extent of malignant PVT (black arrow) along the left portal vein and the anterior segmental branch of the right portal vein. The more distinct enhancing area (black arrowhead) within the malignant PVT is shown within the more dilated portal vein.
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F1
Abdominal CT scan showed liver cirrhosis without parenchymal mass and PVT with mild enhancement in the mild dilated right portal vein (17 mm in diameter; Fig. 1A). Liver MRI also revealed only PVT with mild enhancement within mild dilated right portal vein (17 mm in diameter) in cirrhotic liver without evidence of parenchymal mass (Fig. 1B and C). PVT diameter was greater (22 mm) than the CT findings on admission. There was also no parenchymal mass on follow-up MRI. Percutaneous ultrasound-guided biopsy of the PVT was performed (Fig. 1D). The PVT was pathologically confirmed to be a HCC (Fig. 1E). However, the right hepatectomy could not be done, because, 20 days later, the pre-operative CT revealed that the PVT in the right portal vein had extended to the left and the main portal vein had a greater diameter (23 mm; Fig. 1F).