PMC4531621_01
(A) CT scan showing narrowed intrahepatic vena cava, hypertrophied caudate lobe, mild ascites, and moderate splenomegaly with focal splenic infarction. (B) MR imaging showing obliterated hepatic veins and diffusely narrowed intrahepatic vena cava.
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The patient underwent abdominal dynamic computerized tomography (CT) scan (Figure 1A) and magnetic resonance imaging (MRI) (Figure 1B), which revealed a hypertrophied caudate lobe of the liver, splenomegaly, obliterated hepatic veins, and the narrowing of the intrahepatic vena cava.
Venogram of the liver showing broad stenosis of the intrahepatic vena cava (arrow) with collateral vessels (arrow head).
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Venography (Figure 2) showed a broad stenosis of the intrahepatic vena cava consistent with the CT and MRI findings.
A and B. Histological findings of the liver showing zone 3 hemorrhage with fibrotic regenerative nodular formation (hematoxylin and eosin stain, x100), and fibrotic expansion of portal area (Masson trichrome stain, x100).
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Liver histopathology obtained by a laparoscopic biopsy revealed zone 3 hemorrhage due to hepatic congestion, chronic inflammatory cell infiltration in the portal area, and fibrotic nodular formation (Figure 3).
Liver dynamic CT scan showing multiple, small, and variably-sized nodules in both hepatic lobes. The nodules were enhanced in the early arterial phase (arrows; A), and washed out in the portal phase (arrows; B), suggesting hepatocellular carcinoma.
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These nodules appeared to be enhanced in the early arterial phase, and washed out in the portal phase (Figure 4).
Selective angiography of the hepatic artery showing multiple, variably-sized, and hypervascular lesions in both hepatic lobes (arrows), indicating hepatocellular carcinoma.
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In addition, the lesions were stained by selective angiography of the hepatic artery (Figure 5), suggesting HCC.