Established cirrhotic changes are seen. Ill-defined infiltrative mass involving the caudate lobe with tumor thrombus involving the left branch of portal vein as well as the main portal vein. Satellites are seen elsewhere suggestive of regenerative or dysplastic nodules rather than small multicentric HCC with tumor thrombus. Portal hypertension, splenomegaly and a small volume of ascites.

The differential diagnosis of small hypervascular liver lesions in a cirrhotic liver includes arterioportal shunts or pseudolesions (for very small lesions), dysplastic nodules, and small HCCs. Occasionally, a cirrhotic liver may have preexisting flash-filling hemangiomas that may mimic malignant lesions.    

Multiphasic magnetic resonance imaging (MRI) including DWI is extremely useful in the detection and characterization of regenerating and dysplastic nodules and small HCCs.