PMC9479747_01
Axial (a) and coronal (b) unenhanced CT of the upper abdomen shows a homogenous spontaneous hyperdense ovoid lesion of 3.2 cm (white arrow). The arterial (c) and venous (d) phase of the contrast enhanced CT shows no enhancement, resulting in hypodense appearance relative to the liver. Compression of the right portal vein (d, black arrow) is depicted. In addition, a segmental splenic infarction is seen (e, white arrow).
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F1
The plain abdominal CT showed a homogenous spontaneously hyperdense nodule of 3.2 cm in liver segment 4 near the hilum (Figure 1). Furthermore, a segmental infarction of the spleen was seen (Figure 1).
Axial (a) and coronal (b) fat-sat T2 and axial T1 (c) sequence show a lesion with a hyperintense periphery and a hypo-intense centre (white arrows). High signal intensity on the DWI (d) and low signal on ADC (e) is noted, confirming diffusion restrictive lesion (white arrows).
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F2
Apparent diffusion coefficient (ADC) values (Figure 2). An occlusion of the right hepatic artery extending into the lesion was suspected (Figure 3), which could not be documented on prior imaging performed months earlier.
The arterial phase MRI shows this structure (partly visualised; black arrow) deriving from the right hepatic artery (white arrow).
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F3
Apparent diffusion coefficient (ADC) values (Figure 2). An occlusion of the right hepatic artery extending into the lesion was suspected (Figure 3), which could not be documented on prior imaging performed months earlier. These clinical and imaging findings are highly suggestive of a (mycotic) thrombosed pseudo-aneurysm of the right hepatic artery (Figure 3).
On this DSA image, the black hollow arrow indicates occlusion of the right hepatic artery, and re-injection is denoted by the white arrow.
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F4
Digital subtraction angiography (DSA) confirmed the occlusion of the right proximal hepatic artery (Figure 4).
The axial (a) and sagittal (b) PET-CT shows avid FDG-uptake in a lesion in the rectum (white arrows).
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F5
A focus of F-18 fluorodeoxyglucose-uptake (FDG-uptake) was seen in the rectal wall (Figure 5), suggestive of malignancy.
Axial (a) and coronal (b) T2-weighted sequence of the lower pelvis, showing a iso-intense semi-circular, sessile mass in the middle 1/3 of the rectum (white arrows).
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F6
MRI of the rectum (Figure 6) confirmed a tumour of the rectal wall, which was already described on colonoscopy.