Cirrhosis of the Liver Community
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Avatar universal


  Hubby went into ungent care with pain in his upper right abdomen. We thought maybe it was gallbladder stuff.   He had a U.S. (HCV type 1, non responder, cirrhosis - compensated).  They found a spot on his liver, approx 2.5 cm by 3 cm.  His AFP came back normal, but we still have an MRI in a few weeks.

The U.S. said it looked like a Hepatoma or a Transient Hepatic Attenuation Differences and something about a shunt.  Does anyone know what a THAD is or a shunt?  What does it do?  Can they do anything for it?  What are the concerns with that?  Is it like a varicose vein or something?

I know that a normal AFP doesn't 100% mean no cancer, but it is a step in the right direction...but there is still something there...

Any info would be greatly appreciated.
8 Responses
446474 tn?1446351282
I am sorry that your husband was hospitalized in pain.

First the doctors need to determine what they are seeing so they need to use a more sensitive tool (dynamic MRI) to view what is exactly happening. Many things can cause increased arterial flow. As you mentioned, a tumor, a shunt, THAD, portal/hepatic vein thrombosis, arterioportal shunts, etc., etc.
Once they can tell what is going on then they can move forward with any step necessary. In my opinion it is best not to speculate as to what is could be as we tend to imagine worse case scenarios that rarely turn out to be the case. While I know it is difficult please try to be patient and wait for further information (dynamic MRI) and then you and your husband will know what to do.

By the way you are correct about AFP. AFP adds little information to HCC diagnosis. The vast majority of HCCs (80%-90%) do not produce AFP in their early stages. Therefore imaging is how HCC is typically diagnosed, not by AFP. AFP in early tumor growth is more indicative of aggressive forms of HCC and later tumor growth.

I am hoping for the best for the both of you!
HCC, MELD score 36, AFP >1000
446474 tn?1446351282
Transient Hepatic Attenuation Difference

Transient hepatic attenuation difference (THAD) is an area of enhancement seen during the hepatic arterial phase of dynamic CT that is caused by an increase in arterial flow. This increase may be primary or in response to decreased portal flow.

Primary causes include hypervascular lesions (the sump effect), inflammation of adjacent organs (e.g., gallbladder, pancreas), or an aberrant hepatic arterial supply.

Decreased portal flow, in turn, can be caused by portal or hepatic vein thrombosis, compression by focal lesions, long-standing biliary obstruction, parenchymal trauma, and arterioportal shunts.

Transient hepatic attenuation difference is classified into four types based on morphology:

Lobar multisegmental: All or almost all segments of one hepatic lobe is involved. Usually caused by a hypervascular lesion that ***** in extra blood to the whole segment. The shape is not triangular shape and a straight border sign (see below) is not seen.

Sectorial: Triangular wedge- or fan-shaped areas with at least one straight border that separates the area of increased attenuation from adjacent normally attenuating liver. Caused by increased arterial flow in response to a portal venous obstruction. A malignant lesion may cause sectorial THAD by compression or infiltration of a portal vein branch. Benign lesions causing sectorial THAD are usually subcapsular. Alternatively, a focal liver abscess can cause portal hypoperfusion by the spread of inflammatory mediators.

Polymorphous: Have various shapes and sizes without a straight border. Present as areas of irregular enhancement around or lateral to an injury. The polymorphous pattern may be caused by an aberrant blood supply, inflammation, physical parenchymal injury (contusion, percutaneous biopsy), chemical parenchymal injury (e.g., ethanol injection for tumor), extrinsic compression by ribs or stretched diaphragmatic pillars, and radiofrequency ablation.

Diffuse: Involves the entire hepatic parenchyma. This pattern is caused by a generalized blood flow obstruction before, at, or after the level of sinusoids, with resultant portal hypoperfusion. The appearance depends on the level of obstruction.

Before: For example, portal vein thrombosis, cirrhosis. Portal flow is inadequate for the periphery of the liver, resulting in a central-peripheral appearance (peripheral subcapsular hepatic enhancement with relative low attenuation of the central perihilar area.

At: For example with dilatation of the biliary tree from choledocholithiasis or pancreatic cancer. The appearance is a peribiliary pattern of transient hepatic attenuation difference.

After: For example, Budd Chiari syndrome, right heart failure. Results in generalized central lobular enhancement with a marbled appearance.

Avatar universal
Thank you Hector...I hope you are feeling ok....I have read many of your posts...I was reading a lot of posts about 1.5 years ago when I was doing hep C treatment for type 2...(SVR BTW :) and was saddened to hear past treatments have gone your way.  Very happy to see you are still hear though to give your advice and wisdom regarding liver related things and life and death in general...your selfless addition to this website is greatly appreciated by many...

we have a MRI on the 18th so we will know more after that...this just came at a weird time cause my husband is on the verge of getting a really good new job that will require a lot of travel, probably only home on the weekends...he had his third interview last night and heard through the rumor mill to expect to hear its a go by tomorrow (keeping our fingers crossed)....we were hoping to know for sure what was up with his liver so we could know what do do about the job...now we are thinking we will go forward with our plans for the job until we have reason not to, trying to keep a cool head about things.  

446474 tn?1446351282
My fingers are crossed for your both too.

317787 tn?1473362051
Hi I am so sorry, I just read this. I think going forward with the job is a good idea.  Keep going til you can't
I hope his MRI goes well.
5611452 tn?1370974704
My thoughts and prayers are with you both.  I'm so very sorry you are going through this.  Best of luck and please keep us posted on everything.

Avatar universal
Well my husband got his results backfrom the MRI and nothing was clarified.  

They basically confirmed what the CT scan said...cirrhosis - no signs of decompensation, and nothing conclusive about the spot...we will find out more when he goes to the Doctor on the 8th...more waiting...

in the meantime he has started his new job on Monday and has been traveling every since...

I would like to go get a copy of the MRI results, but it was through an urgent care and I don't think my husband has signed anything saying I can see his medical stuff yet...he is just now establishing a new family doctor here and then will get set up with a Hep doc...( he didn't have any insurance prior to us being married) and we have only been married for a few months...

Wish someone could just tell us yeah he's ok he just needs to take care of himself and his Hep C or..no he's not ok you need to take these specific steps...this middle ground could drive a person nuts!
5611452 tn?1370974704
I'm glad he went forward with his job.  I know the not knowing is the hardest part.  That's how I am too.  Once I know what is what it is a lot easier to handle because then you have a plan of action.  The best I can say is be patient.  The answers will come.  I do recommend that he keeps copies over everything.  All labs, procedure reports, everything.  I also have a list of all of my meds, the dosage, when/how I take them, who prescribed them and why.  Along with a list of all of my doctors and their phone numbers.  I keep them in an accordion file and bring it with me to every dr appointment and to the er when I have to go there.  All of the Dr's LOVE this.  Then they can see what's going on, see your latest lab results etc.  

Wishing you both the best and keeping you in my prayers,

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317787 tn?1473362051
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