Fig. 4
From: Abdominal imaging findings in adult patients with Fontan circulation
Hepatocellular carcinoma with extensive tumour thrombus in a post-Fontan patient. A 38-year-old woman with previous right atrial isomerism and pulmonary atresia. a Axial CT image in the portal venous phase demonstrates a 1.1-cm iso-attenuated nodule causing surface contour abnormality in segment 2 of the liver (arrow). This lesion was initially reported as regenerative nodule. b-d On 6-month follow-up MRI, the lesion increased to 3.4 cm, showing arterial enhancement (b), washout in 3-min delay (c), and strong diffusion restriction in single-shot echo-planar diffusion-weighted image (b = 1,000 s/mm2) (d). Biopsy confirmed the lesion as HCC and the lesion was successfully treated with radiofrequency ablation (RFA). e Local recurrence of segment II in the dome HCC directly invaded the inferior vena cava (not shown) and subsequently an extensive tumour thrombus developed and filled the inferior vena cava, the right atrium (asterisks) and extended to the left main pulmonary artery