Presentation
Right upper quadrant pain. Previous ultrasound study (images not available) showed a mass in the right flank that is connected to the liver by a vascular pedicle.
Patient Data
There is a large exophytic hepatic mass that shows heterogeneous contrast enhancement, predominantly hypervascular, becoming even more heterogeneous and with appearances of some washout on the portal venous phase. A prominent branch of the hepatic artery is seen feeding the tumor via its pedicle.
Case Discussion
This case brings a challenge, a large hypervascular exophytic hepatic mass assessed only on arterial and portal venous phase (old case collection). The enhancement of the lesion is heterogeneous but markedly hypervascular, with a prominent feeding artery identified. In the portal venous phase, the lesion becomes more heterogeneous and there is a contrast washout, presumed due to arteriovenous shunting. The absence of a noncontrast and delayed phase preclude the assessment of important clues, such as the presence of fat, calcifications, and hemorrhage.
This tumor was resected and announced in an MDM as hepatocellular adenoma NOS.
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