The Thoracic Footprint of Hepatocellular Carcinoma: A Mechanism-Based Imaging Narrative Review.
5 affiliations
- 1"Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania.
- 2Department of Radiology and Medical Imaging, Clinical Hospital of Pneumophthisiology, 700115 Iasi, Romania.
- 3Department of Surgery, "Sf. Spiridon" Clinical Emergency Hospital, 700116 Iasi, Romania.
- 4Pulmonology Clinic, Clinical Hospital of Pneumophthisiology, 700115 Iasi, Romania.
- 5Department of Radiology and Medical Imaging, "Sf. Spiridon" Clinical Emergency Hospital, 700116 Iasi, Romania.
Abstract
A thoracic finding in a patient with hepatocellular carcinoma (HCC) may represent metastatic disease, vascular extension, treatment-related injury, or a complication of cirrhosis, and each carries different implications for staging and care. The mechanism behind the finding therefore matters as much as the finding itself. We searched the PubMed/MEDLINE database for articles published up to August 2026 and screened the reference lists of retrieved articles for additional relevant publications. The narrative review is organised into four domains: direct oncological involvement, vascular dissemination, treatment-related injury, and cirrhosis-associated mimics. Within each domain, computed tomography (CT) provides most of the chest assessment, while magnetic resonance imaging, echocardiography, and angiography address more specific anatomical or diagnostic questions. We next discuss common patterns of pulmonary metastasis alongside benign nodules common in transplant candidates, and the biological and small-lesion limitations of functional imaging. Thoracic findings gain meaning in the context of hepatic disease, vascular anatomy, and treatment history. Enhancement and alpha-fetoprotein have never been validated as noninvasive rule-out tests for pulmonary metastasis, so the choice between sampling and surveillance rests on multidisciplinary judgement of the costs of uncertainty, procedural feasibility, and evidence strength.
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BibTeX
@article{prisacaru2026thoracic,
title = {{The Thoracic Footprint of Hepatocellular Carcinoma: A Mechanism-Based Imaging Narrative Review.}},
author = {Carmen Georgiana Pitusac Prisacaru and Ramona Cadar and Cristian Dumitru Lupascu and David Toma and Adriana Loredana Pintilie and Tudor Birladeanu and Ruxandra Stirbu and Raluca Teodora Tiron and Roxana Cobzariu and Radu Crisan Dabija and Corina Lupascu Ursulescu},
journal = {Diagnostics (Basel, Switzerland)},
year = {2026},
month = sep,
doi = {10.3390/diagnostics16193072},
url = {https://europepmc.org/article/MED/42882227},
note = {CC BY},
}
RIS
TY - JOUR
TI - The Thoracic Footprint of Hepatocellular Carcinoma: A Mechanism-Based Imaging Narrative Review.
AU - Carmen Georgiana Pitusac Prisacaru
AU - Ramona Cadar
AU - Cristian Dumitru Lupascu
AU - David Toma
AU - Adriana Loredana Pintilie
AU - Tudor Birladeanu
AU - Ruxandra Stirbu
AU - Raluca Teodora Tiron
AU - Roxana Cobzariu
AU - Radu Crisan Dabija
AU - Corina Lupascu Ursulescu
PY - 2026
DA - 2026/09/22
JO - Diagnostics (Basel, Switzerland)
DO - 10.3390/diagnostics16193072
UR - https://europepmc.org/article/MED/42882227
AB - A thoracic finding in a patient with hepatocellular carcinoma (HCC) may represent metastatic disease, vascular extension, treatment-related injury, or a complication of cirrhosis, and each carries different implications for staging and care. The mechanism behind the finding therefore matters as much as the finding itself. We searched the PubMed/MEDLINE database for articles published up to August 2026 and screened the reference lists of retrieved articles for additional relevant publications. The narrative review is organised into four domains: direct oncological involvement, vascular dissemination, treatment-related injury, and cirrhosis-associated mimics. Within each domain, computed tomography (CT) provides most of the chest assessment, while magnetic resonance imaging, echocardiography, and angiography address more specific anatomical or diagnostic questions. We next discuss common patterns of pulmonary metastasis alongside benign nodules common in transplant candidates, and the biological and small-lesion limitations of functional imaging. Thoracic findings gain meaning in the context of hepatic disease, vascular anatomy, and treatment history. Enhancement and alpha-fetoprotein have never been validated as noninvasive rule-out tests for pulmonary metastasis, so the choice between sampling and surveillance rests on multidisciplinary judgement of the costs of uncertainty, procedural feasibility, and evidence strength.
SN - 2075-4418
ER -