12.

A 55-year-old man with hepatitis C cirrhosis complicated by a 12 cm hepatocellular carcinoma replacing the entire right liver who underwent sequential TAE followed 1 month later by RPVE prior to a right hepatectomy. (A) Contrast enhanced axial image of the liver demonstrated a 12 cm enhancing mass replacing the right liver and normal appearing of left lateral liver prior to embolization and PVE. (B) Intraprocedural digital subtraction selective angiography demonstrates hypervascular tumor with successful particle embolization. (C) Anteroposterior flush portogram obtained through a 5-F flush catheter within the main portal vein via ipsilateral approach demonstrates patent conventional portal anatomy. (D) Intraprocedural fluoroscopic image from PVE depicts complete occlusion of all branches to right portal vein. (E) Final portogram shows occlusion of the portal vein branches to segments 4–8 with continued patency of the veins supplying the left lateral liver. (F) A single image from post-PVE contrast-enhanced CT scan demonstrates profound necrosis of the tumor (white arrow) and massive hypertrophy of the left lateral liver. The patient underwent uncomplicated right hepatectomy.