Focal nodular hyperplasia - with embolisation

Case contributed by Dr Paresh K Desai

Presentation

65 year old female with abdominal discomfort.

Patient Data

Age: 65
Gender: Female

Findings consistent with focal nodular hyperplasia.

DSA (angiography)

Findings described in case discussion.

Case Discussion

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.

The liver is non-cirrhotic. The Alpha-feto-protein levels were normal.

The patient was taken up for tumor embolisation. The coeliac 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 embolised using PolyVinyl Alcohol particles (250-350micron size). 

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

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

Final Diagnosis: Focal Nodular Hyperplasia (FNH)

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Case information

rID: 12103
Case created: 21st Oct 2010
Last edited: 21st Dec 2016
Inclusion in quiz mode: Included

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