Focal nodular hyperplasia
Abnormal LFT. Normal body habitus. Six years of prior oral contraceptive pill usage from 16 to 22 years.
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The liver appeared normal under the usual abdominal ultrasound settings. The gallbladder and bile ducts also appeared normal.
Liver with low dynamic range: an amorphous, hypoechoic region was visualized within segment VII after the dynamic range was lowered and the liver rescanned. There appeared to be an echogenic central scar. Blood flow appears to have a stellate distribution.
In this case, with an abnormal LFT and an otherwise normal appearing liver, what is being missed? I asked the patient about long-term OCP usage, dropped the dynamic range and had another look.
A hypoechoic area with a central scar and stellate blood distribution pattern was seen in segment VII. These findings point to focal nodular hyperplasia, which was confirmed with a CT scan.