Case of the Day: Liver mass in an Asymptomatic Young Woman

Teaching Point: Although most masses in asymptomatic young women are benign focal nodular hyperplasia, the greyscale features alone are not diagnostic. All masses FNH, Hepatic Adenoma, and HepatoCellular Carcinoma (HCC), may be found in this patient population.

Teaching Point: Bubble tracking technique on CEUS displays accurate filling direction. FNH have centrifugal filling and Adenoma and HCC may both show centripetal filling as here. It makes CEUS a competitor with MR scan performed with liver specific contrast agents providing differentiation of FNH, Adenoma and HCC.

Teaching Point: This can’t be FNH because there is no centrifugal filling, this can’t be HCC because there is no late weak washout. This is Hepatic Adenoma showing sustained enhancement. Sustained Enhancement has a high association with benignancy. However caution is warranted as 20 to 40 percent of Adenomas show Washout. HCC is excluded because there is no Washout.