The patient, a 42-year-old male, was admitted to our department on August 10, 2018 because "physical examination found that the liver occupied space for more than 3 months". The patient found elevated alpha-fetoprotein during physical examination 3 months ago, and MRI of the upper abdomen showed that the liver occupied space, which was considered as hemangioma, and no special treatment was given. Two weeks ago, the patient was re-examined in another hospital for alpha-fetoprotein>1 210 μ g/L. Abdominal CT examination showed that the right lobe of the liver occupied space, and blood was supplied by the right hepatic artery. He was considered to be liver cancer. For further diagnosis and treatment, he went to our hospital. The patient had a history of hepatitis B virus carrier for 42 years without oral antiviral treatment, and the rest of the past history and personal history were not special. Admission physical examination: abdominal swelling, no abnormalities were found in the rest. Laboratory test: Red blood cell count 5.98×1012/L, ALT 54 U/L, AST 51 U/L, total bilirubin 26.2 μ mol/L, direct bilirubin 6.2 μ mol/L, indirect bilirubin 20.0 μ mol/L, γ-glutamyl transpeptidase 202 U/L, hepatitis B virus 2.48×104U/ml, alpha-fetoprotein 5 162 μ g/L. Child-Pugh is rated A. Abdominal CT examination (FIG. 1A): Giant round slightly lower density mass shadow in the right lobe of the liver, the larger layer is about 8.0 cm ×7.8 cm, and the enhanced scan has uneven enhancement, showing "fast forward and fast out" performance; Multiple abnormal enhanced nodules were seen around the lesion and the left lobe of the liver, the larger one was about 10.5 mm ×9.0 mm; The boundary between the local branches of the right hepatic vein and the lesion is unclear, and it becomes thinner under pressure; Liver volume measurement: Liver segments 2 and 3 are about 241.122 cm34 segments of liver about 142.495 cm3520.771 cm in segments 5 and 8 of the liver3； The diagnosis considers that hepatocellular carcinoma is likely, and multiple abnormal enhancement foci in the remaining liver are considered as sub-foci or metastases, and local invasion of the right hepatic vein may be possible. CT angiography (FIG. 1B) shows that the right lobe of the liver is supplied by the right hepatic artery branch. Abdominal MRI dynamic scan (gadoxetate disodium injection) (Figure 1C): A huge round mass shadow was seen in the right lobe of the liver, and no uptake was seen in the hepatocyte phase; Multiple abnormal enhanced nodules were observed around the four segments of the right and left lobes of the liver, and the uptake of hepatocyte phase was reduced to varying degrees; The diagnosis was considered to be primary liver cancer in the right lobe of the liver, multiple sub-foci in the four segments of the right and left lobes of the liver, tumor thrombus in the right anterior branch of the portal vein, invasion of the right hepatic vein, and cirrhosis.
