Presentation
PH breast cancer. Non-specific abdominal pain, suspicious lesion on US of liver. CT and MRI for clarification.
Patient Data
Peripheral posterior right lobe "mass" - peripheral and wedge-shaped
Initial dynamic contrast enhanced scans show reduced enhancement in the posterior right hepatic lobe with absent right portal vein. Delayed imaging following an hepatocyte excreted agent (Primovist) shows very extensive reduced/absent enhancement in the right lobe = hepatocyte deficiency in the right lobe with an absent (attenuated) right portal vein and atrophy indicative of chronic portal vein occlusion (no cause determined). Compensatory hypertrophy of left lobe with normal enhancement.
Case Discussion
Primovist is of great value in assessing liver lesions as it "stains" the hepatocytes on delayed imaging. Helps to determine if a liver lesion contains hepatocytes eg FNH and also helps to detect lesions that do not compared with the normal liver eg metastases or in this case chronic hepatic infarction/atrophy due to portal vein occlusion.
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