PMC7266071_01
Gray-scale US image shows the left portal vein expanded with occlusive tumor thrombus (white arrow)
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fig1
US, and strain sonoelastography examinations were performed by an experienced radiologist with a Logiq S7 Expert machine (GE Healthcare, Milwaukee, WI) equipped with a C1-5-D convex probe. US examination revealed diffuse inhomogeneous left hepatic lobe without any localized formation and significant dilatation of the left portal vein (26 mm) with thrombus extending into the right portal vein (Fig. 1, Fig. 2).
Axial contrast-enhanced CT images show streaky and heterogeneous enhancement of the PV thrombus during the late arterial phase
(A)
with washout during the portal venous phase
(B), which is diagnostic of tumor thrombus
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fig3
A and B). Additionally, a tumor thrombus with a similar enhancement pattern was demonstrated within the left and right portal veins (Fig. 3 A and B).
On sonoelastographic image, normal parenchyma is coded in red-green color (star mark), whereas portal vein tumor thrombosis and the affected left lobe parenchyma are coded in blue-green (black arrow) and pure blue color (white arrow), respectively. Based on the color bar on the left side, red color reflects less stiff tissue, while blue color reflects more stiff tissue than the rest. Besides, green color reflects medium-stiff tissue
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fig4
Given the lack of a discrete mass lesion, the sonoelastography-guided biopsy was performed from the left liver lobe parenchyma (Fig. 4).