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Case of the Month

September 2012

Patient Data: 20 year old female patient

Clinical Info: Pain in the right upper abdomen

There is an inhomogeneous focal liver lesion

Another image of the same lesion. There are hypoechoic and anechoic parts

There is peripheral vascularity

There is also vascularity within the lesion. When a mass lesion in the liver is found in a young female patient one should think about a hepatic adenoma. Always inform about the use of oral contraceptives. In this case the patient uses oral contraceptives. When a mass is inhomogeneous and painful think about a hemorrhage in a hepatic adenoma

CT scan art. phase

CT scan venous phase The diagnosis hemorrhage in a hepatic adenoma was confirmed

CT scan of the same patient some time later after stopping the oral contraceptives. The lesion is smaller

Ultrasound scan of a 32 year old female patient also using oral contraceptives. She had severe pain in the right abdomen

Another image of the same patient. The liver is very inhomogeneous and there is a perihepatic hematoma.

There is a large perihepatic hematoma. In this case again our initial diagnosis was hemorrhage of a hepatic adenoma. The patient went inmediately to the CT scan

46477-liver_hemorrhage.swf CT without contrast (The contrast in the gallbladder was the result of an ERCP the previous day because the gastroenterologist thought she had bile duct stones)

46480-liver_hemorrhage.2_avi.swf CT art. phase

46478-liver_hemorrhage.3_avi.swf CT venous phase

46479-liver_hemorrhage.4_avi.swf CT late phase Again the diagnosis hemorrhage in a hepatic adenoma was confirmed. There are several adenomas. The patient was treated in a university center

Ultrasound scan of a 36 year old patient with slightly hypoechoic but homogeneous mass lesion also using oral contraceptives. The lesion was an incidental findings.

Another image of the large lesion

The lesion is vascularized

Another image of the large lesion

46485-adenoma_1.swf CT without contrast

46486-adenoma_2.swf CT art phase

46487-adenoma_3.swf CT Late phase In this case the adenoma was an incidental finding in an asymptomatic patient without a hemorrhage

When a liver lesion is found in a young female patient who uses oral contraceptives always think of a liver adenoma. Liver adenomas can cause a hemorrhage that can be minor as in the first patient or very severe as in the second case.

For more examples of liver adenomas see

Copyright © Dr. T.S.A. Geertsma, Ziekenhuis Gelderse Vallei, Ede, The Netherlands. All rights reserved.

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