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Case 104: Liver lesion

A 52 year old woman with a history of hepatitis C and alcohol abuse presents with a rising alpha foetoprotein. Conventional imaging has failed to detect an abnormality.

1. What is the study and the diagnosis?

CT hepatic angiogram. The hepatic artery is cannulated via a femoral puncture and contrast is injected intra-arterially with immediate scanning through the liver. There is a hypervascular lesion in segment III of the liver that is likely to be a hepatocellular carcinoma in this setting. The liver contour is

2. What is the anatomic basis for performing this study?

Hepatocellular carcinomas usually derive their blood supply predominantly from the hepatic arterial system as opposed to the portal venous system which is dominant in the normal liver. Therefore these hypervascular lesions are well demonstrated on hepatic arterial contrast studies.