Presentation
Incidental finding on CT abdomen for epigastric abdominal pain.
Patient Data
Incidental vascular mass lesion in right hepatic lobe on the background of a very fatty liver (arrow)
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).
Appearances are unchanged after 6 months (if anything the lesion is slightly smaller)
- Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.
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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