Close follow-up of patients with liver cirrhosis has led to increased detection of hepatocellular carcinoma (HCC) at an early stage, especially with magnetic resonance imaging (MRI) innovations. We report the case of a 70-year-old man, with a recent history of liver cirrhosis due to chronic hepatitis C virus (HCV) complicated by hepatocellular carcinoma (HCC), and for whom trans-arterial chemoembolization (TACE) was planned, as the patient was assigned Child B7 at admission. Angiography performed during the first TACE cycle shows not only the "tumor blush" corresponding to previously detected HCC but also an additional small foci of HCC uptake seen within a large dysplastic nodule giving the appearance of "nodule-within-nodule." Early detection of hepatocellular carcinoma improves prognosis. Hence, it is essential to be aware of all early aspects of HCC, including the nodule-within-nodule appearance on cross-sectional imaging, and also in angiography, as in this case.
Keywords: ALT, Alanine amino-transferase; AST, aspartate aminotransferase; Alpha-FP, alpha-fetoprotein; BP, blood pressure; CBC, complete blood count; Chemoembolization; DSA, Digital subtraction angiography; Dysplastic nodule; Early HCC; HBV, hepatitis B virus; HCC, hepatocellular carcinoma; HCV, hepatitis C virus; HCV-Ab, HCV antibodies. T1-WI, T1-weighted images; HIV, human immunodeficiency virus; LDH, lactate dehydrogenase; MRI, magnetic resonance imaging; NR, normal range; Nodule-within-nodule; PR, Pulse rate; PT, prothrombin time; RAHA, right anterior hepatic artery; RR, respiratory rate; T2-WI, T2-weighted images; TACE, trans-arterial chemoembolization.
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