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Purpose: Thalassemia (HbH) is a chronic condition that may have potential complications of liver cirrhosissecondary to iron overload or hepatitis. Iron deposition in the liver can mask the classic imaging findings ofhepatocellular carcinoma. We report an interesting case with similar nature with diagnostic dilemma, wheremultiple imaging modalities were unable to delineate the nature of the liver nature, and the patient waseventually diagnosed with hepatocellular carcinoma, after percutaneous biopsy was performed.Method: A 61-year-old male, with background history of HbH disease and transfusion dependent, presentedwith an incidental finding of 2 liver nodules on an ultrasound scan after complaints of right hypochondriumpain. A computed tomography (CT) scan diagnosed one nodule as a flash-filling haemangioma but wasinconclusive about the other larger nodule. A magnetic resonance imaging (MRI) scan was also inconclusivebut gave the differentials of extramedullary haematopoiesis. A sulphur colloid scan did not show uptake,making extramedullary haematopoiesis less likely.Results: A percutaneous biopsy of the indeterminate liver nodule was performed, and the histology showedhepatocellular carcinoma. The patient underwent wedge resection of the hepatocellular carcinoma andrecovered well post-operatively.Conclusion: In the event of inconclusive imaging in patients with significant risk factors for hepatocellularcarcinoma, a percutaneous biopsy should be performed for definitive diagnosis.

A Diagnostic Dilemma of Hepatocellular Carcinoma on a Background of Thalassemia