Focal nodular hyperplasia is usually a very subtle finding on ultrasound unless there is a background of steatosis.
In this case, with an abnormal LFT and an otherwise normal appearing liver, what is being missed? I asked the patient about long-term OCP usage, dropped the dynamic range and had another look.
A hypoechoic area with a central scar and stellate blood distribution pattern was seen in segment VII. These findings point to focal nodular hyperplasia, which was confirmed with a CT scan.