Case of the Day: What do we do about that Hilar Mass?

Teaching Point:

Ultrasound is a great modality for the identification of thrombus in the Portal Vein. This is an expansive luminal Mass continuous with the RPV. Expansive thrombus can be acute or malignant. Additional imaging is required to further characterize this thrombus.

Teaching Point:

Enhancement of the Thrombus at Arterial Phase Washin. Contrast Enhanced ultrasound accurately shows blood flow at the perfusion level. Notice the filling of the Hepatic Artery, and then quick Enhancment of this Portal vein thrombus with vessels extending from the Hepatic Artery.

Teaching Point:

Washout of the Portal vein Thrombus. Here you no longer see enhancment in the Portal Vein. Arterial Phase Enhancment of a Portal Vein Thrombus (Image 2), followed by washout in the Portal Venous Phase (Image 3) is diagnostic of Malignant Portal Vein Thrombosis!! In a patient at-risk for Hepatocelluar Carcinoma this is categorized a LR-TIV or LI- RADS Tumor in vein.