1. Clinical History Patient presents with a palpable upper abdominal mass Patient states possible clinical history of abdominal hernia

2. Sonographic Findings

3. Large mass in the midline upper abdomen Appears to originate from left lobe of liver

4. Sonographic Findings Appears to represent a conglomeration of individual masses Appears to represent a conglomeration of individual masses

5. Color Flow Seen Within Mass

6. Right Liver Liver is enlarged No obvious masses seen within right lobe of liver by ultrasound

7. Results discussed with patient’s physician Patient scheduled for CT same day

8. CT Results Multiple liver masses Dominant mass replaces lateral left lobe with a large exophytic component (20cm) Appearance suggestive of malignancy with multiple metastases-primary origin unknown Ultrasound guided liver needle biopsy of left lobe of liver was preformed 1 week later

9. Pathology Report 3 Liver needle core biopsies were sent to cytology Findings: –Hepatocellular Carcinoma –Moderately differentiated, with associated lesional necrosis

10. Hepatocellular Carcinoma Most common primary malignant neoplasm of the liver Composed of epithelial cells Male predominance Symptoms –Palpable mass, hepatomegaly, fever, signs of cirrhosis

11. Hepatocellular Carcinoma Doppler may show tumor invasion in the hepatic veins, IVC, or portal vein Patients often have advanced stages of disease at the time of diagnosis, witch negatively affects survival rate Survival rate of approximately 1% at 5 years

12. Normal Liver Normal liver parenchyma should appear homogenous & display mid level echogenicity