This 37-year-old Saudi Arabian male presented with a past medical history significant for glycogen storage disease, hepatitis C, and subsequent cirrhosis. He is a candidate for liver transplantation. During his transplant evaluation, multiple hypoechoic liver masses were identified on ultrasound. This prompted performance of Computed Tomography (CT) for further evaluation. CT revealed 2 hyperattenuating lesions in the left lobe measuring 1.5 x 2 cm and 1.5 x 1.5 cm in the lateral and medial segments respectively (Figures 1-2). Multiple small non-enhancing nodules were also present. Because of the multiple lesions with and without enhancement, a Gallium scan was performed. This demonstrated the two areas corresponding to the hyperattenuating lesions to be Gallium avid and compatible with hepatocellular carcinoma (HCC).

Debate ensued about whether to treat these lesions with radiofrequency ablation (RFA) or to treat the entire left lobe of the liver with chemoembolization in consideration of the adenomas. After discussion, it was decided to treat the patient with chemoembolization considering some of the smaller lesions could be malignant but below the resolution capabilities of nuclear medicine. After accessing the left hepatic artery, a mixture of cisplatin, adriamycin, mitomycin-C, and gelfoam powder was slowly injected until stasis was reached. Aside from visualization of the expected 2 vascular lesions, no other vascular masses were delineated. The patient tolerated the procedure well and was discharged home 2 days later.

Fig. 2.The larger, more inferior lesion is present in the posterior aspect of the lateral segment of the left lobe of the liver.