Focal nodular hyperplasia - with embolization

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 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 the gastroduodenal artery.

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

Final Diagnosis: Focal Nodular Hyperplasia (FNH)

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Case information

rID: 12103
Published: 21st Oct 2010
Last edited: 4th Feb 2020
Inclusion in quiz mode: Included