Focal nodular hyperplasia - exophytic

Case contributed by Dr Domenico Nicoletti

Patient Data

Age: 50 years
Gender: Female

CT Abdomen

In the lower margin of the right lobe of the liver there is a nodular exophytic lesion measuring 3 cm, hypervascular in the arterial phase and isodense to the liver in the portal phase. Three other nodular formations with the same density characteristics of 1.5 cm, 1 cm, and 0.7 cm are detectable in VII, I and II segments respectively. 


MRI Liver

The exophytic lesion with thin central scar and the other hepatic lesions, after infusion of hepatobiliary contrast agent, show intense enhancement in the arterial phase and then become isointense in portal, balance and hepatobiliary phase. There is also a hypo-vascularized non-specific small nodule in the fourth segment (6 mm).

The lesions are compatible with focal nodular hyperplasia (FNH) nodules.

Annotated image

Position of the exophytic lesion. 

Case Discussion

Focal nodular hyperplasia (FNH) is a benign lesion caused by hyperplastic response of hepatocytes in the presence of an abnormal blood vessel. The contraceptive pill acts on growth but does not affect the formation.

FNH is a hamartoma, may be multiple, and is found more in the right lobe below the Glisson’s capsule. There is a central fibrous scar in the larger forms (> 5 cm). Typical appearances is the proliferation of the bile ducts malformed that communicate poorly or do not communicate at all with the biliary system of the adjacent parenchyma.

Case courtesy: Dr.ssa Barbara Severini and Dr Fabio Denicolò.

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Case information

rID: 44104
Published: 8th Apr 2016
Last edited: 14th Aug 2019
Inclusion in quiz mode: Excluded