Axis cuts following oral and intravenous contrast injection with Liver scanning in hepatic arterial phase (HAP), portal venous phase (PVP), and equilibrium phase.
- Established cirrhotic changes in the farm of bulky left and caudate lobes, irregular contour and parenchymal dysmorphism.
-III-defined hepatic lesions are seen; at segment VIII averaging 4.7 x 2.7 cm and at Segment III averaging 3 x 2.5 cm: Following IV contrast administration, faint contrast uptake is noted in the HAP with evident gradual wash out in the PVP and equilibrium phases. Other focal lesions could not be entirely rule out on back ground of such parenchymal dsymorphism and preferential perfusion … Features suggestive of multi-focal HCC on top of cirrhotic liver … for AFP correlation.
-The left portal vein is thrombosed. The main and right veins are patent yet with evidence of arterio-portal shunting.
- Vascular anatomical variant: RHA originating from the SMA.
- Very fine intra biliary radicles dilatation could be seen at Segment VIII secondary to mass effect.
Signs of portal hypertension included:
-Portal vein is seen dilated averaging 15.5 mm in caliber and still patent with out evidence of thrombosis nor AV Shunting.
-Spleen is seen enlarged 17.6 cm in maximum bipolar diameter. Still of homogeneous tissue matrix and no focal lesions.
-Related nearby porto-systematic venous collaterals are seen normally at lieno-renal, peri-easophageal and eosaphago-gastric regions.
-Recancalized para-umbilical vein.
-Mesenteric congestion and mild to moderate amount of ascites is seen.
Large right renal upper cortical cyst averaging 8 x 6 cm showing fine internal septae with fine calcification … Bosinak Type 11 for follow up. Otherwise both kindneys are normal in size, shape and position. No renal stones, expanding lesions or back pressure changes identified.
The pancreas is of normal matrix; no calcifications or focal lesions identified. No pancreatic duct dilatation.
Right and left spura renal glands are normal.
The retrocrural, para-aortic abdominal and pelvic lymph nodes are normal.
Scans through pelvis showed bulky prostate.