Inflammatory hepatic adenoma

Case contributed by Dr Chris O'Donnell


Incidental finding on CT abdomen for epigastric abdominal pain.

Patient Data

Age: 21-year-old
Gender: Female

Incidental finding on CT

Incidental vascular mass lesion in right hepatic lobe on the background of a very fatty liver (arrow)


Primovist (hepatocyte-concentrated) MR contrast agent

Markedly fatty liver with substantial loss of signal in the liver on the out of phase sequence as compared with the spleen.  Mass lesion in right hepatic lobe showing peripheral rim of T2 signal with slightly lower signal intensity to the central T2 signal increase.  Arterial phase enhancement with central core of absent enhancement persisting during the delayed phase (so-called atoll sign).


Follow-up MRI after 6 months

Appearances are unchanged after 6 months (if anything the lesion is slightly smaller)

Case Discussion

There are 4 subtypes of hepatocellular adenoma: inflammatory hepatocellular adenoma, hepatocyte-nuclear-factor-1-alpha (HNF-1alpha-mutated) hepatocellular adenoma, beta-catenin-mutated hepatocellular adenomas and unclassified. 

The most common is the inflammatory subtype and is usually seen in young women with obesity, hepatic steatosis (as in this case), diabetes mellitus and alcohol abuse.  Classic appearance is T2 hyperintensity with delayed, persistent, peripheral contrast enhancement with an hepatocyte agent (Primovist) as in this case.  Differential diagnosis is focal nodular hyperplasia.

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Case information

rID: 43301
Published: 13th Mar 2016
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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