EURORAD ESR

Case 14164

Pseudocirrhosis secondary to chemotherapy of breast cancer liver metastases

Author(s)
Tonolini Massimo, MD.

"Luigi Sacco" University Hospital, Radiology Department; Via G.B. Grassi 74 20157 Milan, Italy; Email:mtonolini@sirm.org
 
Patient
female, 30 year(s)
 
 
  • Figure 1
    Initial contrast-enhanced multidetector CT (baseline)
     

    Axial (a) thoracic and coronal (b) images showed right-sided malignant pleural effusion (*) with pleural thickening and masses (arrowheads) and lung atelectatic consolidations (+).

     
    Area of Interest: Lung; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Metastases;

    Right-sided malignant pleural effusion (*) with pleural thickening and masses (arrowheads) and lung atelectatic consolidations (+). Enlarged liver disseminated with innumerable peripherally-enhancing lesions...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Metastases;

    Abdominal axial post-contrast images (a...c in craniocaudal order) showed hepatomegaly with regular margins, disseminated with innumerable peripherally-enhancing lesions consistent with hypovascular metastases,...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Metastases;

    Abdominal axial post-contrast images (a...c in craniocaudal order) showed hepatomegaly with regular margins, disseminated with innumerable peripherally-enhancing lesions consistent with hypovascular metastases,...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Metastases;

    Abdominal axial post-contrast images (a...c in craniocaudal order) showed hepatomegaly with regular margins, disseminated with innumerable peripherally-enhancing lesions consistent with hypovascular metastases,...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Metastases;
     
     
  • Figure 2
    First follow-up contrast-enhanced multidetector CT (4 months)
     

    The malignant right-sided pleural effusion (*) decreased, with partial persistence of pleural masses (arrow in b). Note resolving lung atelectasis (*)

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Metastases;

    Decreasing malignant right-sided pleural effusion (*), with partial persistence of pleural masses (arrow in b). Persistent hepatomegaly with decreased number and size of disseminated liver metastases compared to Fig.1

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Metastases;

    Detail coronal (c) and axial (d...f) images showed persistent hepatomegaly with decreased number, size and enhancement of disseminated liver metastases compared to Fig.1, interpreted as positive therapeutic response.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Metastases;

    Detail coronal (c) and axial (d...f) images showed persistent hepatomegaly with decreased number, size and enhancement of disseminated liver metastases compared to Fig.1, interpreted as positive therapeutic response.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Metastases;

    Detail coronal (c) and axial (d...f) images showed persistent hepatomegaly with decreased number, size and enhancement of disseminated liver metastases compared to Fig.1, interpreted as positive therapeutic response.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Metastases;

    Detail coronal (c) and axial (d...f) images showed persistent hepatomegaly with decreased number, size and enhancement of disseminated liver metastases compared to Fig.1, interpreted as positive therapeutic response....

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Metastases;
     
     
  • Figure 3
    Second follow-up contrast-enhanced multidetector CT (8 months)
     

    Further follow-up showed decreasing liver enlargement compared to previous studies in Figs.1 and 2; further regression of treated metastases; and appearance of band-shaped nonenhancing areas (*). Note resolved...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Metastases;

    Further follow-up showed decreasing liver enlargement compared to previous studies in Figs.1 and 2; further regression of treated metastases; and appearance of band-shaped nonenhancing areas (*).

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Metastases;

    Further follow-up showed decreasing liver enlargement compared to previous studies in Figs.1 and 2; further regression of treated metastases; and appearance of band-shaped nonenhancing areas (*).

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Metastases;

    Further follow-up showed decreasing liver enlargement compared to previous studies in Figs.1 and 2; further regression of treated metastases; and appearance of band-shaped nonenhancing areas (*).

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Metastases;

    Further follow-up showed decreasing liver enlargement compared to previous studies in Figs.1 and 2; further regression of treated metastases; and appearance of band-shaped nonenhancing areas (*). Note lobulated liver...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Metabolic disorders;

    Further follow-up showed decreasing liver enlargement compared to previous studies in Figs.1 and 2; further regression of treated metastases; and appearance of band-shaped nonenhancing areas (*). Note lobulated liver...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Metastases;
     
     
  • Figure 4
    Third follow-up contrast-enhanced multidetector CT (14 months)
     

    Further follow-up showed shading off of liver metastases, liver shrinkage, progression of band-shaped nonenhancing areas (*).

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Metastases;

    Further follow-up showed shading off of liver metastases, liver shrinkage, progression of band-shaped nonenhancing areas (*).

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Metastases;

    Further follow-up showed shading off of liver metastases, liver shrinkage, progression of band-shaped nonenhancing areas (*), development of multifocal capsular retraction (arrowheads).

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Metastases;

    Further follow-up showed shading off of liver metastases, liver shrinkage, progression of band-shaped nonenhancing areas (*), development of multifocal capsular retraction (arrowheads).

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Metastases;

    Further follow-up showed shading off of liver metastases, liver shrinkage, progression of band-shaped nonenhancing areas (*), development of multifocal capsular retraction (arrowheads).

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Metastases;
     
     
  • Figure 5
    Fourth and final follow-up contrast-enhanced multidetector CT (23 months)
     

    Ultimately, progressive liver shrinkage and development of several band-like nonenhancing regions (*) was confirmed, causing multifocal capsular retraction (arrowheads) and bulging contours of spared parenchymal...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Metastases;

    Ultimately, progressive liver shrinkage and development of several band-like nonenhancing regions (*) was confirmed, causing multifocal capsular retraction (arrowheads) and bulging contours of spared parenchymal...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Metastases;

    Ultimately, progressive liver shrinkage and development of several band-like nonenhancing regions (*) was confirmed, causing multifocal capsular retraction (arrowheads) and bulging contours of spared parenchymal...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Metastases;

    Ultimately, progressive liver shrinkage and development of several band-like nonenhancing regions (*) was confirmed, causing multifocal capsular retraction (arrowheads) and bulging contours of spared parenchymal...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Metastases;

    Ultimately, progressive liver shrinkage and development of several band-like nonenhancing regions (*) was confirmed, causing multifocal capsular retraction (arrowheads) and bulging contours of spared parenchymal...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Metastases;

    Ultimately, progressive liver shrinkage and development of several band-like nonenhancing regions (*) was confirmed, causing multifocal capsular retraction (arrowheads) and bulging contours of spared parenchymal...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Metastases;

    Ultimately, progressive liver shrinkage and development of several band-like nonenhancing regions (*) was confirmed, causing multifocal capsular retraction (arrowheads) and bulging contours of spared parenchymal...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Metastases;
     
     
Axial (a) thoracic and coronal (b) images showed right-sided malignant pleural effusion (*) with pleural thickening and masses (arrowheads) and lung atelectatic consolidations (+).
 
Right-sided malignant pleural effusion (*) with pleural thickening and masses (arrowheads) and lung atelectatic consolidations (+). Enlarged liver disseminated with innumerable peripherally-enhancing lesions consistent with hypovascular metastases, measuring up to 5 cm in size.
 
Abdominal axial post-contrast images (a...c in craniocaudal order) showed hepatomegaly with regular margins, disseminated with innumerable peripherally-enhancing lesions consistent with hypovascular metastases, measuring up to 5 cm in size.
 
Abdominal axial post-contrast images (a...c in craniocaudal order) showed hepatomegaly with regular margins, disseminated with innumerable peripherally-enhancing lesions consistent with hypovascular metastases, measuring up to 5 cm in size.
 
Abdominal axial post-contrast images (a...c in craniocaudal order) showed hepatomegaly with regular margins, disseminated with innumerable peripherally-enhancing lesions consistent with hypovascular metastases, measuring up to 5 cm in size. Note vertebral metastasis (thick arrow).
 
The malignant right-sided pleural effusion (*) decreased, with partial persistence of pleural masses (arrow in b). Note resolving lung atelectasis (*)
 
Decreasing malignant right-sided pleural effusion (*), with partial persistence of pleural masses (arrow in b). Persistent hepatomegaly with decreased number and size of disseminated liver metastases compared to Fig.1
 
Detail coronal (c) and axial (d...f) images showed persistent hepatomegaly with decreased number, size and enhancement of disseminated liver metastases compared to Fig.1, interpreted as positive therapeutic response.
 
Detail coronal (c) and axial (d...f) images showed persistent hepatomegaly with decreased number, size and enhancement of disseminated liver metastases compared to Fig.1, interpreted as positive therapeutic response.
 
Detail coronal (c) and axial (d...f) images showed persistent hepatomegaly with decreased number, size and enhancement of disseminated liver metastases compared to Fig.1, interpreted as positive therapeutic response.
 
Detail coronal (c) and axial (d...f) images showed persistent hepatomegaly with decreased number, size and enhancement of disseminated liver metastases compared to Fig.1, interpreted as positive therapeutic response. Appearance of unifocal capsular retraction (arrowhead).
 
Further follow-up showed decreasing liver enlargement compared to previous studies in Figs.1 and 2; further regression of treated metastases; and appearance of band-shaped nonenhancing areas (*). Note resolved pleuropulmonary changes at right lung base.
 
Further follow-up showed decreasing liver enlargement compared to previous studies in Figs.1 and 2; further regression of treated metastases; and appearance of band-shaped nonenhancing areas (*).
 
Further follow-up showed decreasing liver enlargement compared to previous studies in Figs.1 and 2; further regression of treated metastases; and appearance of band-shaped nonenhancing areas (*).
 
Further follow-up showed decreasing liver enlargement compared to previous studies in Figs.1 and 2; further regression of treated metastases; and appearance of band-shaped nonenhancing areas (*).
 
Further follow-up showed decreasing liver enlargement compared to previous studies in Figs.1 and 2; further regression of treated metastases; and appearance of band-shaped nonenhancing areas (*). Note lobulated liver margins and focal capsule retraction (arrowhead in f).
 
Further follow-up showed decreasing liver enlargement compared to previous studies in Figs.1 and 2; further regression of treated metastases; and appearance of band-shaped nonenhancing areas (*). Note lobulated liver margins and focal capsule retraction (arrowhead in f).
 
Further follow-up showed shading off of liver metastases, liver shrinkage, progression of band-shaped nonenhancing areas (*).
 
Further follow-up showed shading off of liver metastases, liver shrinkage, progression of band-shaped nonenhancing areas (*).
 
Further follow-up showed shading off of liver metastases, liver shrinkage, progression of band-shaped nonenhancing areas (*), development of multifocal capsular retraction (arrowheads).
 
Further follow-up showed shading off of liver metastases, liver shrinkage, progression of band-shaped nonenhancing areas (*), development of multifocal capsular retraction (arrowheads).
 
Further follow-up showed shading off of liver metastases, liver shrinkage, progression of band-shaped nonenhancing areas (*), development of multifocal capsular retraction (arrowheads).
 
Ultimately, progressive liver shrinkage and development of several band-like nonenhancing regions (*) was confirmed, causing multifocal capsular retraction (arrowheads) and bulging contours of spared parenchymal regions. No signs of metastatic reappearance.
 
Ultimately, progressive liver shrinkage and development of several band-like nonenhancing regions (*) was confirmed, causing multifocal capsular retraction (arrowheads) and bulging contours of spared parenchymal regions. No signs of metastatic reappearance.
 
Ultimately, progressive liver shrinkage and development of several band-like nonenhancing regions (*) was confirmed, causing multifocal capsular retraction (arrowheads) and bulging contours of spared parenchymal regions. No signs of metastatic reappearance.
 
Ultimately, progressive liver shrinkage and development of several band-like nonenhancing regions (*) was confirmed, causing multifocal capsular retraction (arrowheads) and bulging contours of spared parenchymal regions. No signs of metastatic reappearance.
 
Ultimately, progressive liver shrinkage and development of several band-like nonenhancing regions (*) was confirmed, causing multifocal capsular retraction (arrowheads) and bulging contours of spared parenchymal regions. No signs of metastatic reappearance.
 
Ultimately, progressive liver shrinkage and development of several band-like nonenhancing regions (*) was confirmed, causing multifocal capsular retraction (arrowheads) and bulging contours of spared parenchymal regions. No signs of metastatic reappearance.
 
Ultimately, progressive liver shrinkage and development of several band-like nonenhancing regions (*) was confirmed, causing multifocal capsular retraction (arrowheads) and bulging contours of spared parenchymal regions. No signs of metastatic reappearance.
 
 
 
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