Season 9 Case 8

Hx: 30yo female w abdominal pain

Answer: Hepatic Adenoma with hemorrhage

Multiple hyperenhancing hepatic masses in a young female. Largest in left lobe within internal hyperdensity (blood) and capsular irregularity consistent with extracapsular hemorrhage (hepatic rupture).

Hepatic Adenomas:

-Benign

-m/c hepatic tumor in young females classically on OCPs

-stimulated by estrogen (OCPs, obesity, anabolic steroid use)

-typically asymptomatic

-prone to hemorrhage which can even yield exsanguination!

Hepatic Adenomas Imaging:

Classic:

-solitary  (>10 = adenomatosis)

-large (5-15cm) at dx

-subcapsular, R hepatic lobe

-well defined -Ca++ uncommon (old bleed)

-US: varies

-CT: isodense to liver, early enhancement but iso-enhancing by portal venous phase. Hyperdense in a fatty liver or when containing hemorrhage

MR: T1 variable, T2 mild increased, +fat ->phase drop out

-contrast: early arterial enhancement then iso on delay (like CT)

-hemorrhage can distort this

Nucs: photopenic defect on Tc-99 sulfur colloid ( increased number & function of Kupffer cells)