| A Case Report of Advanced Hepatocellular Carcinoma Missed on Ultrasonography |
Tom Ryu1, Jae Young Jang1
, Young Chang1, Soung Won Jeong1 |
1Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
2Department of Pathology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea, Seoul, Korea |
| Address for Correspondence: |
Jae Young Jang ,Tel: 82-2-709-9863, Fax: 82-2-709-9696, Email: jyjang@schmc.ac.kr
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Received: 8 October 2025; Accepted: 11 November 2025. Published online: 11 November 2025. |
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| ABSTRACT |
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We report a case of a 59-year-old man with chronic hepatitis B–related liver cirrhosis who developed diffuse hepatocellular carcinoma (HCC) with portal vein thrombosis (PVT) within only six months despite ongoing antiviral therapy. Importantly, the initial surveillance ultrasonography failed to detect any definite malignant lesion, and serum alpha-fetoprotein remained within the normal range, presenting the potential limitation of ultrasound in identifying early or infiltrative forms of HCC.
At the 6-month follow-up, new-onset PVT was incidentally found on ultrasound, which became the key diagnostic clue leading to the detection of infiltrative HCC.
Transarterial chemoembolization and radiation therapy, followed by splenic artery embolization for thrombocytopenia management were performed. Subsequently, multidisciplinary discussion enabled curative left hemihepatectomy with portal thrombectomy, which was successfully performed.
This case highlights that even in regular surveillance programs, HCC may be missed on initial ultrasonography, emphasizing the need for careful assessment of subtle vascular or parenchymal changes and the importance of integrating complementary imaging modalities when needed.
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| Keywords:
Hepatocellular carcinoma; Portal vein thrombosis; Ultrasonographic surveillance; Missed case on ultrasonography |
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