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What is your differential at this point?
A large T2 hyperintense mass with a centrally more hyperintense region is compatible with focal nodular hyperplasia, haemangioma, a metastasis, or possibly well-differentiated hepatocellular carcinoma (HCC). This patient has no risk factors for HCC and no known primary. There is only a single lesion in the liver. If deciding between hemangioma and FNH, the lesion T2 hyperintensity favors hemangioma. Don't be thrown by the central "scar".
There is a relatively well-marginated mass in the right lobe of the liver measuring 11.3 x 6.9 x 14.3 cm.
- majority of the lesion is moderately T2 hyperintense, with central irregular regions that are even more T2 hyperintense
- T1 hypointense
- no loss of signal on the out-of-phase sequence
- no ascites or perihepatic fluid
- no evidence of cirrhosis or portal hypertension
- displays mass effect on adjacent vessels