Radiologist Misses Fatal Hepatocellular Carcinoma

This case involves a forty-nine-year-old male patient admitted to the hospital for severe abdominal pain. A CT-abdomen done at this admission showed a poorly defined mass on the medial portion of the right hepatic lobe. The CT with contrast revealed several fluid collections near the liver and a possible abscess in the right lobe of the liver. Interventional radiology placed drains and infectious disease was consulted for medication options. The patient was reassured and told he only had gallstones and could be followed as an outpatient for an elective cholecystectomy. Approximately 5 months later, the patient again had severe abdominal pain and experienced a syncopal episode. He was again worked up for all possible causes and it is at this point a delayed diagnosis of metastatic carcinoma is revealed.

Question(s) For Expert Witness

1. What is the most accurate imaging study to diagnose a hepatocellular carcinoma before it seeds to distant locations?

Expert Witness Response

Oftentimes, it is hard to diagnose hepatocellular carcinoma in the early stages as there are no pathognomonic features to distinguish this disease from others; however, if the patient has risk factors (i.e hepatitis C) and shows clinical symptoms, an abdominal ultrasound should be done to identify the possibility of hepatocellular carcinoma. The patient should have an abdominal ultrasound every six months as a screening measure. While ultrasound is commonly used for screening, it does not provide sufficient anatomic detail and thus the MRI can be utilized without the risk of radiation and contrast.