Presentation
Bilateral loin pain. Incidentally noted is a hepatic mass lesion.
Patient Data
A relatively large 8 X 7 cm isoechoic right liver lobe segment V exophytic mass lesion.
The liver is mildly enlarged in size with homogeneous parenchyma as well as smooth regular outline. A relatively large and well-defined right liver lobe anterior inferior segment exophytic hepatic focal lesion is noted about 8.0 x 7.0 x 6.5 cm in its maximal craniocaudal and axial dimensions. The lesion shows predominantly isointense T1 and T2 signal intensity with a central scar of T2 hyperintensity. The lesion shows intense post-contrast enhancement in the arterial phase and appearing with isointense signal with the liver parenchyma in the portal-venous phases. The T2 hyperintense central scar is noted enhancing in the delayed venous phase. The lesion is abutting and mildly compressing the anterior wall of the gall bladder which appears otherwise unremarkable with no stones, masses or pericholecystic collection. The rest of the abdominal viscera is grossly unremarkable.
Case Discussion
The differential diagnosis of such an arterially enhancing lesion in a non-cirrhotic liver is a fibrolamellar HCC (T2 hypointense non-enhancing scar with calcifications). Other differential diagnoses are hypervascular metastatic deposit or a flash-filling hemangioma (much smaller). The lesion ultimately was biopsied and focal nodular hyperplasia (FNH) was confirmed.
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