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British Journal of Radiology (2005) 78, 841-844
© 2005 British Institute of Radiology
doi: 10.1259/bjr/37052159
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Hepatocellular carcinoma tumour thrombus in a re-canalised para-umbilical vein: detection by 18-fluoro-2-deoxyglucose positron emission tomography imaging

C J Beadsmoore, MRCP, FRCR 1 H K Cheow, MRCP, FRCR 1 E Sala, PhD, FRCR 2 D J Lomas, FRCP, FRCR 2 P Gibbs, FRCS 3 V Save, MBChB, MRCPath 4 M E D Alison, MRCP 5 and K K Balan, MD, FRCP 1

Departments of 1 Nuclear Medicine, 2 Radiology, 3 Surgery, 4 Pathology and 5 Hepatology, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK



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  		Figure 1. Transabdominal ultrasound of the upper abdomen demonstrating a serpiginous structure within the anterior peritoneal cavity containing echogenic material with peripheral Doppler signal (arrow). The appearances are consistent with a re-canalised para-umbilical vein containing thrombus.

 


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  		Figure 2. Arterial phase contrast-enhanced CT showing a small liver with an irregular margin containing an area of abnormal enhancement in the right lobe, consistent with an hepatocellular carcinoma on a background of cirrhosis (arrowhead). The serpiginous structure seen on ultrasound is demonstrated (arrow), with a little peripheral enhancement.

 


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  		Figure 3. Whole-body orthogonal 18F-FDG PET images show irregularly increased FDG uptake in the right lobe of the liver (long arrow) indicating active tumour. There is also abnormal metabolic activity (arrowhead) anterior to the liver in the abdomen corresponding to the para-umbilical vein indicating viable tumour. Note extravasation of FDG into left elbow.

 


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  		Figure 4. (a) Hepatocellular carcinoma (HCC) in para-umbilical vein. Tumour filling large calibre vein with adjacent smaller thrombosed vein. (b) HCC medium power. Medium power image of tumour.

 




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