Hepatic metastasis - follicular thyroid carcinoma

Case contributed by Ahmed Magdy Abouelatta
Diagnosis almost certain


A patient with a history of total thyroidectomy with postoperative chemotherapy and radiotherapy for routine metastatic workup. A hepatic focal lesion was noted on a single-phase contrast-enhanced assessment warranting triphasic assessment of a hepatic focal lesion.

Patient Data

Age: 50 years
Gender: Female

A large left hepatic lobe relatively well-defined hypodense lesion showing few scattered hyperdense foci on precontrast phases. Contrast-enhanced phases showed peripheral and less pronounced central arterial enhancement with irregular filling the subsequent contrast-enhanced phases with incomplete filling at the end of the delayed phase.

Case Discussion

Hepatic focal lesions with pa eripheral enhancement pattern should not be solely thought of as hemangioma or an atypical variant of it. Despite being noted on an earlier study, this focal hepatic lesion didn't raise suspicion, being regarded as an atypical hemangioma rather than anything else. Upon performing a radioactive iodine-131 scan on the liver, abnormal activity was noted that indicated functioning thyroid remnant or metastasis (not provided). A new CT triphasic study was performed and histopathological correlation was suggested. Biopsy results (not shown here) came to the suspected conclusion: metastatic follicular thyroid carcinoma.

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