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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


46466-Afbeelding1.jpg
There is an inhomogeneous focal liver lesion


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


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There is peripheral vascularity


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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


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CT scan art. phase


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


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


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


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


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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


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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.


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Another image of the large lesion


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The lesion is vascularized


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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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