case_images: PMC10795173_01
case_images: Conventional US revealed a mass (A, B) in the right lobe of the liver; CEUS showed irregular hyperenhancement with non-enhancement areas in the arterial phase (C), then washed out early in the portal venous phase (D), and finally marked washed out in the late phase (E). CT revealed a heterogeneous low-density mass in the right lobe of the liver (F); CECT showed mild-to- moderate heterogeneous enhancement in the arterial phase (G) and portal venous phase (H) in the mass. The enhancement degree was more obvious in the delayed stage (I). US, ultrasonography; CEUS, contrast-enhanced ultrasonography; CECT, contrast-enhanced computed tomography.
case_images: fonc-13-1229936-g001.jpg
case_images: PMC10795173_01_fonc-13-1229936-g001.jpg
case_images: f1
case_images: Contrast-enhanced US (CEUS) demonstrated earlier enhancement, displaying an irregular hyperenhancement pattern with multiple non-enhancement areas within during the arterial phase, then washout early in the portal venous phase, and eventually marked washout in the late phase ( Figures 1A-E ). The mass involving segments V, VII, and VIII, the right branch of the portal vein was not clearly visualized, possibly due to tumor invasion ( Figures 1F-I ). Multiple lymph nodes were identified in the hilar region, peripancreatic region, and portacaval space, some of which demonstrated metastatic disease ( Figures 1F-I ).
case_images: Clinical course. The time course of WBC, N, ALP, GGT, CA19-9, SCC, and PCT. Therapies and tumor size are indicated at the bottom. WBC, white blood cell; N, neutrophil; ALP, alkaline phosphatase; GGT, gamma glutamyl transpeptidase; CA19-9, carbohydrate antigen 19-9; SCC, serum squamous cell carcinoma antigen; PCT, procalcitonin.
case_images: fonc-13-1229936-g002.jpg
case_images: PMC10795173_01_fonc-13-1229936-g002.jpg
case_images: f2
case_images: The clinical course is shown in  Figure 2 .