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Synchronous focal liver lesions in a patient with liver cirrhosis: commonplaces may be misleading
  1. Giorgia Ghittoni1,
  2. Eugenio Caturelli2,
  3. Sandro Rossi1
  1. 1IRCCS Policlinico San Matteo, Medicina VI Ecografia Interventistica Pavia, Italy
  2. 2Ospedale Belcolle, Unità Operativa di Gastroenterologia Viterbo, Italy
  1. Correspondence to Dr Giorgia Ghittoni, IRCCS Policlinico San Matteo, Medicina VI Ecografia Interventistica Pavia, Italy; giorgiaghittoni{at}gmail.com

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We read the article by Sangiovanni et al1 reporting that in patients with cirrhosis with a 1–2 cm nodule detected during surveillance, a single, typical contrast pattern imaging technique confidently permits diagnosis of hepatocellular carcinoma (HCC), reducing the need for fine needle biopsy (FNB).

However, some concerns arise regarding the authors' conclusions. We report the case of a 70-year-old man with hepatitis C virus (HCV)-related cirrhosis. The patient had a history of third hepatic segmental hepatectomy for HCC nodule, 12 years before. He also had undergone left hemicolectomy for colorectal cancer (CRC) and left lung lobectomy for lung metastasis, 6 years later. The patient was actually referred for the assessment of three focal hepatic lesions.

To characterise the focal lesions, contrast-enhanced (CE) spiral abdominal CT and ultrasound (US) scan plus CE-US were planned. All imaging techniques revealed three focal lesions in liver segments IV, VI …

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