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Enhancing and Expansile Portal Vein Thrombosis: Value in the Diagnosis of Hepatocellular Carcinoma in Patients with Multiple Hepatic Lesions

Zarine K. Shah1, Margaret G. McKernan, Peter F. Hahn and Dushyant V. Sahani

1 All authors: Department of Abdominal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St., White 270, Boston, MA 02114.


Figure 1
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  		Fig. 1A —57-year-old man with jaundice. Axial T2-weighted MR image shows expanded right branch (arrow) of portal vein with high signal intensity within it.

 

Figure 2
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  		Fig. 1B —57-year-old man with jaundice. Axial unenhanced T1-weighted image at same level as A shows expanded right branch (arrow) of portal vein.

 

Figure 3
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  		Fig. 1C —57-year-old man with jaundice. Contrast-enhanced axial MR image shows enhancement and expansion of thrombus (arrow) within right branch of portal vein. Patient also had heterogeneously enhancing mass in liver (not shown), which was diagnosed as hepatocellular carcinoma at histopathologic examination.

 

Figure 4
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  		Fig. 2 —63-year-old man with histologically proven hepatocellular carcinoma. Axial contrast-enhanced CT scan in arterial phase shows thrombus in right and left branches of portal vein. Expansion of left branch of portal vein and enhancement of thrombus (arrow) are evident. Arterioportal shunt is evident as linear streaks of contrast enhancement (chevron) in region of right branch of portal vein.

 

Figure 5
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  		Fig. 3 —53-year-old woman with lower abdominal pain. Axial contrast-enhanced CT scan of liver shows thrombus (arrowhead) in left branch of portal vein. Vessel is of normal caliber, and there is no enhancement of thrombus within it. This patient also had metastatic lesions in liver from carcinoma of right ovary.

 

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