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Focal nodular hyperplasia

Case contributed by Roberto Schubert
Diagnosis possible

Presentation

The patient underwent CT to confirm songraphically suspected nepholithiasis. No other medical problems. No steroid medication.

Patient Data

Age: 55 years
Gender: Male
ct

5 cm hypervascular lesion in the left liver lobe (segments 2,3) bulging out the liver surface. The lesion is homogenously isodense on non-contrast and late equilibrium phase scans, which do not show central scarring.

mri

On MRI the lesion is practically isointense to the liver on T2- and T1 in phase and opposed phase GRE images. On DWI, it is slightly hyperintense. Dynamic contrast enhancement is te same as on CT, with even more intense contrast enhancement in the early arterial than in the portal venous phase.

Case Discussion

Attenuation values and signal intensities similar to the liver on non-enhanced CT and MR series, and early enhancement suggest a lesion originating from the liver cells - focal nodular hyperplasia (FNH) is favored over hepatic adenoma. Hepatocellular carcinoma would be rather unusual in a homogeneous lesion of this size.

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