Presentation
Abdominal pain and elevated liver enzymes. Left upper abdominal stiffness and mass feeling on physical exam.
Patient Data
A large mass with vivid early enhancement and a central scar is noted in the left liver lobe. On delayed images, the mass becomes isodense with surrounding parenchyma although delayed enhancement could be seen in the central scar and peripheral rim of the mass. Multiple prominent vascular structures are noted around the mass.
Case Discussion
The patient underwent liver mass resection and histopathology evaluation confirmed focal nodular hyperplasia (FNH).
FNH is the second most common benign liver lesion after hemangioma. On non-contrast CTscan images, the lesion is usually hypo- or iso-attenuating and a hypoattenuating central scar can be seen in up to 60% of lesions >3 cm in size. After contrast media injection, typical FNH demonstrates bright homogeneous arterial contrast enhancement except for the central scar which remains hypoattenuating. The fibrotic scar shows enhancement on delayed scans in up to 80% of cases.
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