Background: Ultrasonography and computed tomography belong to standard diagnostic approach to hepatocelullar carcinoma arising in cirrhotic liver. In majority of cases these methods show high sensitivity in detection of large tumours.
Case report: A 64 yr-old male patient presented with loss of weight, ascites of unknown origin and abnormal hepatic laboratory tests. The ultrasonography revealed marked heterogeneity of the liver and
cavernous transformation of the portal vein. Hepatic imaging with computed tomography showed multiple, ill-circumscribed and slightly hyperattenuating foci which were found in the hypovascular liver. No liver mass was detectable. The portal vein showed no opacification on postcontrast scans and the inferior vena cava was compressed by enlarged caudate lobe. The
laparoscopy, which was done for explanation of high level of serum alpha-fetoprotein, disclosed the large tumour in the right lobe of cirrhotic liver.
Conclusions: Invasion of large vessels by primary liver cancer may mask the tumour mass behind the postischemic parenchymal lesions, making the antemortem diagnosis of this cancer difficult.

Keywords: hepatocellular carcinoma, ischaemic liver, portal vein thrombosis