A 62-year-old man with hepatocellular carcinoma is being assessed for transarterial chemoembolization. Which finding on his workup represents an absolute contraindication to conventional TACE?

• A Portal vein thrombosis involving the main portal vein trunk ✓
• B Serum alpha-fetoprotein level of 800 ng/mL
• C Mild ascites controlled with diuretics
• D Platelet count of 90 x 10^9/L

Explanation

TACE relies on the dual blood supply of the liver: tumor is fed by the hepatic artery while the cirrhotic parenchyma is protected by portal venous inflow. Thrombosis of the main portal vein removes this protective supply, so arterial occlusion risks acute liver failure. Controlled ascites and mild thrombocytopenia are relative concerns addressed by supportive care, not absolute contraindications.

Reference: Grainger and Allison's Diagnostic Radiology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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