​Case Presentation

60 yo M presents to clinic for an incidentally found hepatic lesion on CT. It is 3cm in segment 6 of the liver.

It was found following panscans from an MVC with no traumatic injuries.

-Cantlie line divides the liver into right and left, and lies along the middle hepatic vein (NOT falciform!)
-Horizontal plan divided by the portal vein
-Functionally independent segments

​

Couinard Classification of Hepatic Segments

He denies any current symptoms.
His PMH only includes HTN, well controlled with one medication.
His last colonoscopy was 8 years ago, normal, and was told to follow up in 10 years. He has no known hx of hepatitis or cancer.
Denies any family history of cancer.
He denies smoking, drinking, IVDU, or any other drug use.

On physical exam, he is obese with a BMI of 35.
It is otherwise unremarkable; he is in no acute distress, no abdominal distension, no ascites, no palpable masses, no blood on DRE, no caput medusae, etc.

Calculates 3-month mortality from liver disease, traditionally used for liver transplants
Has variations to include other important factors like sodium levels (MELD-Na, MELD combined)

MELD score

Used to predict morality from cirrhosis, and grade severity of liver disease. Often used to predict outcomes from other major surgeries.

Child-Pugh score

CLIP scoring
0 = 42.5 months 1 = 32.0 months
2 = 16.5 months 3 = 4.5 months
4 = 2.5 months 5-6 = 1 month

All the labs are within normal limits, except AFP, which is 100.

Li-Rads scoring is used for liver lesions in patients with cirrhosis, to predict likelihood that lesion is HCC given the features seen on CT

Arterial phase

Venous phase

Capsule enhancement

Barcelona Clinic Liver Cancer (BCLC) staging