Focal nodular hyperplasia associated with cavernous hemangioma of the liver.

HISTORY: Right upper quadrant pain, rule out gallstones.

FINDINGS: Images 1-5 are transverse scans of the liver.  In Image 1

there is a well-defined echogenic mass seen in the posterior segment of

the right lobe of the liver.  Images 2 and 3 demonstrate a mass in the

anterior segment of the right lobe that has slightly increased

echogenicity compared to normal liver (arrows, Image 2).  Images 4 and 5

are color Doppler sonograms of the mass in the anterior segment of the

right lobe demonstrating intrinsic flow.

DIAGNOSIS: Focal nodular hyperplasia associated with cavernous

hemangioma of the liver.

 

DISCUSSION: There is an increased incidence of focal nodular hyperplasia

(FNH) in patients with hemangioma of the liver.  Sonographically,

hemangiomas demonstrate a variable appearance, but when small, they are

typically hyperechoic in appearance with slight distal enhanced through

sound transmission.  An important negative finding is lack of a

peripheral hypoechoic halo and a lack of refractive shadowing.  FNH may

be quite subtle to detect with grayscale imaging as the echogenicity is

very similar to the normal liver.  The color Doppler sonograms are

useful to demonstrate increased intrinsic flow within the lesion quite

typical of FNH.  Intrinsic flow can also be seen with malignant lesions

such as hepatocellular carcinoma and some metastatic lesions.

Therefore, this finding is nonspecific and requires other confirmatory

studies such as nuclear medicine examination or MRI.