Focal nodular hyperplasia

Case contributed by Hein Els
Diagnosis possible


Abdominal pain

Patient Data

Gender: Female

Circumscribed hypoechoic lesion in the right lobe of the liver. Doppler shows prominent vascular structures in the lesion creating a spoke wheel appearance, confirmed at contrast enhanced ultrasound (CEUS). The lesion shows centrifugal enhancement. 

Case Discussion

CEUS is more sensitive than CT or MR at demonstrating the spoke wheel sign. The sign is highly suggestive of FNH, but scirrhous hepatocellular carcinoma may also demonstrate this sign at CEUS and should be included in the differential diagnosis for lesions with a spoke wheel sign shown at CEUS.

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