Unusual Presentations
• Obstructive jaundice: is the initial presentation in 1-12% of cases. It is due to compression of the major intrahepatic bile duct by the tumor, invasion of HCC into the lumen of intrahepatic bile ducts, infiltration of the wall of bile ducts causing obliteration of the lumen, hemobilia, or free-floating tumor plugs into the biliary tree.
• Acute abdomen: is a life-threatening complication caused by rupture of the tumor causing intraperito bleeding. It occurs in later stages of the tumor and is a frequent cause of death.
• Obstruction of splanchnic veins: tumor may invade the portal vein, hepatic veins and inferior vena cava, resulting in portal hypertension (with ascites and variceal bleeding), Budd-Chiari syndrome and pitting edema of lower limbs.