young woman with insidious abdominal pain

 

Images

Doctor's Information

Name : Alireza
Family :Almasi
Affiliation : Radiology Department,Firoozgar Hospital,TUMS
Academic Degree: Associate Professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Maryam Dadashpour

 

Case Section

Abdominal Imaging

 

Patient's Information

Gender : Female
Age : 30

 

Clinical Summary

A young woman with insidious abdominal pain

 

 

Imaging Findings

A young woman with insidious abdominal pain Imaging Findings: : Triphasic CT scan is performed that shows a huge lobulated but relatively well-defined mass arising from Rt. Lobe of liver with mass effect on sorrounding parenchyma marked contrast enhancement in arterial phase (more than liver parenchyma) and a central zone of unenhancement (central scar). In portal venous and delayed phase(about 8 min after arterial phase) images the mentioned mass is isidense with liver parenchyma.

 

Differential Diagnosis

Hepatic Adenoma, Fibrolamellar carcinoma

 

Final Diagnosis

FNH (Focal Nodular Hyperplasia)

 

Discussion (Related Text)

Focal nodular hyperplasia (FNH) is the second most common benign liver tumor after hemangioma. These are benign lesions that do not require treatment but must be differentiated from hepatic adenoma and fibrolamellar carcinoma. Most lesions are smaller than 5 cm in diameter. In contrast to hepatic adenoma, hemorrhage, necrosis, and infarction are extremely rare in FNH. Similar to hepatic adenoma, FNH is found most commonly in women, but it is twice as common as hepatic adenoma and is not related to oral contraceptive use. Most tumors (80% to 95%) are solitary. On CT, MR,and US, most tumors appear homogeneous and solid. Acentral core scar with radiating septa is characteristic but present in only 60%. The typical finding on contrast-enhanced CT and MR is intense, brief (approximately 1 minute), uniform tumor enhancement during the arterial phase. The lesion is often isodense during the portal phase, with enhancement of the central scar on delayed images. On MR, FNH appears homogeneous and isointense to slightly hypointense to normal parenchyma on TlWIs and isointense to slightly hyperintense on T2WIs. The central scar is hypointense on TlWIs and hyperintense on T2WIs.

 

References

Brant W.E., Helmes C.A., Fundamentals of diagnostic radiology. 3rd. Edition, Lippincott Williams & Wilkins, Philadelphia, 2007.

 

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