Focal nodular hyperplasia

This is a benign tumour made up of a proliferation of liver cells with hepatocytes, Kupffer cells and biliary and fibrous elements. It is most commonly found in young women and is usually discovered by chance, being asymptomatic. Its ultrasound characteristics vary, and it may be indistinguishable
from hepatic adenoma.
It tends to affect the caudate lobe and has the appearance of a homogeneous mass often of similar echogenicity to the liver (Fig. below). It presents a diagnostic difficulty both with CT and ultrasound, as its characteristics can vary. Colour Doppler shows an increased arterial flow in the mass. The administration of an ultrasound contrastn gent displays a characteristic ‘spoked-wheel’ pattern of arteries with a central scar. The diagnosis can usually be confirmed on MRI scanning (which shows a similar vascular pattern to that of ultrasound contrast scanning) but may occasionally require biopsy proof. Management of this benign mass is usually conservative, with ultrasound follow-up, once the diagnosis has been established, but surgical resection may be necessary in larger lesions.
(FIG. A.B.C )
(A) Focal nodular hyperplasia in the left lobe (arrows), which is isoechoic with normal liver tissue.
(B) Following administration of microbubble contrast agent, the FNH displays a ‘spoked-wheel’ pattern of vascular
enhancement during the early arterial phase. (C) The same lesion seconds later, showing a central scar.

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