A 73-year-old man presented with abdominal bloating. His past medical history was significant for peptic ulcer disease with partial gastrectomy, hypertension and a remote smoking history. Investigations included contrast-enhanced computed tomography of the abdomen, which revealed innumerable hypervascular lesions, with early enhancement in the arterial phase. These were larger and more frequent in the right lobe of the liver, although they were also present in the left lobe. Most lesions measured 1.0 cm to 2.0 cm in diameter but there was a dominant lesion measuring 7.0 cm x 4.1 cm (Figure 1) in segments 5 and 8 of the right hepatic lobe. No extrahepatic or nodal metastases were identified. Serum alpha- fetoprotein level was 74.8 µg/L (normal level is less than 9 µg/L). Core biopsy of the liver confirmed multifocal grade II hepatocellular carcinoma.