Intrahepatic fetus: unusual image of an intratumoural haemorrhage

Description

A 65-year-old man presented to our institution with acute onset, right upper quadrant pain, on a background of rheumatoid arthritis and asthma. He was a lifelong non-smoker, with minimal alcohol consumption and no intravenous drug use. CT and MRI demonstrated a large tumour involving the entire segment IV of the liver positioned between the middle and the left hepatic veins. A T1-weighted axial MRI at the level of right hepatic vein demonstrated an odd, fetus-like lesion within the mass (figure 1). Junior medical staff questioned whether this could be a primary hepatic pregnancy. However, they were reassured that this image portrayed an intraparenchymal bleed, consistent with hepatocellular carcinoma (HCC). A diagnosis of HCC was confirmed by non-invasive criteria for diagnosing HCC recommended by both the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver consensus statement.

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