Focal nodular hyperplasia - with embolization

Case contributed by Paresh K Desai
Diagnosis certain


Abdominal discomfort

Patient Data

Age: 65 years
Gender: Female

Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.

After an initial ultrasound, multiphase CT of the abdomen is performed. The CT reveals a nodular mass in the left lobe of liver involving the segments IIA and IIB. The mass shows an intense enhancement in the arterial phase. The tumor is supplied by the left hepatic artery which is hypertrophied. The portal venous phase reveals mass becoming isodense to the liver parenchyma. There are early draining veins from the mass. No definite central scar is seen. The mass appears to project along the inferior margin of the left lobe of liver.

Findings consistent with focal nodular hyperplasia.

The patient was taken up for tumor embolization. The celiac artery was cannulated using a 5F left coronary bypass curve catheter. The same catheter was used to selectively catheterize the feeding left hepatic artery and the tumor embolized using PolyVinyl Alcohol particles (250-350micron size). 

The post embolization angiogram reveals preserved right hepatic artery, gastric artery and gastroduodenal artery.

Case Discussion

The liver is non-cirrhotic. The Alpha-fetoprotein levels were normal.

Biopsy of the tumor was performed a few weeks after embolization to exclude malignant etiology.

Final Diagnosis: Focal Nodular Hyperplasia (FNH)

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