- 56 y.o. lady with past medical history including
- CAD, CVA, hypertension, prediabetes, former tobacco use,
- asthma, hypothyroidism, GERD,
US 17 years prior
Within the posterior inferior right lobe of the liver there was a round structure measuring 2.6 x 1.9 x 2.4 cm. It had a hyperechoic rim with peripheral flow seen by power Doppler.
Ultrasound shows a 2.6 x 1.9cms vascular mass in the right lobe of the liver
Subsequent pathology confirmed a diagnosis of hepatic adenomatosis
Ashley Davidoff MD The CommonVein.net
Ultrasound shows a 2.6 x 1.9cms vascular mass in the right lobe of the liver
Subsequent pathology confirmed a diagnosis of hepatic adenomatosis
Ashley Davidoff MD The CommonVein.net
CT 16 years Prior with Innumerable Hypervascular Liver Lesions
Innumerable hypervascular liver lesions which did not demonstrate diagnostic features on CT. Differential diagnostic considerations include both benign and malignant hypervascular liver lesions including hepatic adenomatosis, atypical FNH, atypical hemangiomata, or hypervascular metastases.
3. Enlarged left renal vein and suprarenal inferior vena cava of uncertain etiology and significance.
CT scan of the liver 16 years prior shows innumerable hypervascular liver lesions Differential diagnostic considerations include both benign and malignant hypervascular liver lesions including hepatic adenomatosis, atypical FNH, atypical hemangiomata, and hypervascular metastases.
Subsequent pathology confirmed a diagnosis of hepatic adenomatosis
Ashley Davidoff MD The CommonVein.net
CT scan of the liver 16 years prior shows innumerable hypervascular liver lesions Differential diagnostic considerations include both benign and malignant hypervascular liver lesions including hepatic adenomatosis, atypical FNH, atypical hemangiomata, and hypervascular metastases.
Subsequent pathology confirmed a diagnosis of hepatic adenomatosis
Ashley Davidoff MD The CommonVein.net
CT scan of the liver 16 years prior shows innumerable hypervascular liver lesions Differential diagnostic considerations include both benign and malignant hypervascular liver lesions including hepatic adenomatosis, atypical FNH, atypical hemangiomata, and hypervascular metastases.
Subsequent pathology confirmed a diagnosis of hepatic adenomatosis
Ashley Davidoff MD The CommonVein.net
CT scan of the liver 16 years prior shows innumerable hypervascular liver lesions Differential diagnostic considerations include both benign and malignant hypervascular liver lesions including hepatic adenomatosis, atypical FNH, atypical hemangiomata, and hypervascular metastases.
Subsequent pathology confirmed a diagnosis of hepatic adenomatosis
Ashley Davidoff MD The CommonVein.net
CT scan of the liver 16 years prior shows innumerable hypervascular liver lesions Differential diagnostic considerations include both benign and malignant hypervascular liver lesions including hepatic adenomatosis, atypical FNH, atypical hemangiomata, and hypervascular metastases.
Subsequent pathology confirmed a diagnosis of hepatic adenomatosis
Ashley Davidoff MD The CommonVein.net
CT scan of the liver 16 years prior shows innumerable hypervascular liver lesions Differential diagnostic considerations include both benign and malignant hypervascular liver lesions including hepatic adenomatosis, atypical FNH, atypical hemangiomata, and hypervascular metastases.
Subsequent pathology confirmed a diagnosis of hepatic adenomatosis
Ashley Davidoff MD The CommonVein.net
CT scan of the liver 16 years prior shows innumerable hypervascular liver lesions Differential diagnostic considerations include both benign and malignant hypervascular liver lesions including hepatic adenomatosis, atypical FNH, atypical hemangiomata, and hypervascular metastases.
Subsequent pathology confirmed a diagnosis of hepatic adenomatosis
Ashley Davidoff MD The CommonVein.net
4 Years Ago Significant Growth With
8cms Lesions in the Right and Left Lobe
CT showed multiple liver nodules, hypervascular in nature with manifestations of arteriovenous shunting , corkscrew arteries and prominent hepatic veins, with progressive enlargement of multiple
lesions (between 5 and 6 lesions) over the last 12 years
The lesion in segment 3 was originally about 2.2 cm and now measures 8 cm, and is situated on the anterior aspect of the liver. The lesion in segment 5 has also grown significantly to almost 8cms as well.
Significant Progression of Disease with 2 Large Lesions
CT scan of the liver 4 years prior shows significant progression of disease with an 8cms hypervascular mass in the left lobe of the liver
Subsequent pathology confirmed a diagnosis of hepatic adenomatosis
Ashley Davidoff MD The CommonVein.net
Significant Progression of Disease with 2 Large Lesions
CT scan of the liver 4 years prior shows significant progression of disease with an 8cms hypervascular mass in the left lobe and an 8cms mass in the right lobe of the liver
Subsequent pathology confirmed a diagnosis of hepatic adenomatosis. The left lesion was surgically removed and the right sided mass was embolized
Ashley Davidoff MD The CommonVein.net
Since these lesions are extremely hypervascular and relatively
superficial, , and therefore subject to trauma and rupture, it would
be prudent for this patient to be referred to hepatobiliary surgery,
and or for discussion at a combined hepatobiliary interdisciplinary
conference.
Hypervascularity and with Enlarged hepatic Veins and IVC likely from A-V Shunting
CT scan of the liver 4 years prior shows significant progression of disease with innumerable enlarging hypervascular liver lesion with very large masses in the left and right lobes of the liver
Differential diagnostic considerations include both benign and malignant hypervascular liver lesions including hepatic adenomatosis, atypical FNH, atypical hemangiomata, and hypervascular metastases.
Subsequent pathology confirmed a diagnosis of hepatic adenomatosis
Ashley Davidoff MD The CommonVein.net
Significant Progression of Disease with 2 Large Lesions
CT scan of the liver 4 years prior shows significant progression of disease with innumerable enlarging hypervascular liver lesion with very large masses in the left and right lobes of the liver. This image shows a large left hepatic vein, likely from arteriovenous (a-v) shunting in the tumors.
Differential diagnostic considerations include both benign and malignant hypervascular liver lesions including hepatic adenomatosis, atypical FNH, atypical hemangiomata, and hypervascular metastases.
Subsequent pathology confirmed a diagnosis of hepatic adenomatosis
Ashley Davidoff MD The CommonVein.net
2 Years Ago Surgery Left Hepatectomy
CT scan of the liver following right hepatectomy and showing residual large tumor in the right lobe of the liver
Subsequent pathology confirmed a diagnosis of hepatic adenomatosis.
Ashley Davidoff MD The CommonVein.net
Pathology
Hepatocellular adenomas with features of steatosis.
CT Follow Up 2 year ago s/p Left Hepatectomy
Residual Mass in Right Lobe
CT scan of the liver following left hepatectomy and showing residual large tumor in the right lobe of the liver
Diagnosis of hepatic adenomatosis.
Ashley Davidoff MD The CommonVein.net
Angiogram and Right Lobe Liver Biopsy 2 year ago
Ultrasound guided biopsy of a segment 5/6 hepatic tumor was performed with two, 18 G x 2 cm core biopsy samples obtained and submitted for pathology which revealed a diagnosis of hepatic adenoma.
Hepatic Angiography Demonstrates a Right Hepatic Artery Branch Supplying a Segment 5/6 Hepatic Adenoma.
S/P Left Hepatectomy 2 Years Ago
Hepatic angiography demonstrates a right hepatic artery branch supplying a segment 5/6 hepatic tumor. There is significant hypervascularity of the tumor
Pathology confirmed a diagnosis of hepatic adenomatosis.
Ashley Davidoff MD The CommonVein.net
Angiogram and Right Lobe Liver S/P Left Hepatectomy 2 Years Ago
Delayed imaging shows homogeneous enhancement of the large tumor with multiple foci of enhancing smaller nodules
Pathology confirmed a diagnosis of hepatic adenomatosis.
Ashley Davidoff MD TheCommonVein.net
Post Embolization with 100-300 um embospheres to the Right Hepatic Artery Branch Supplying a Segment 5/6 Hepatic Adenoma Demonstrates Lack of Blood Flow to the Tumor.
Current Post Hepatectomy and Embolisation
Current CT shows homogeneously enhancing small nodule next to the IVC in the right lobe of the liver s/p left hepatectomy and embolization of a large lesion in the right lobe of the liver
Pathology confirmed a diagnosis of hepatic adenomatosis.
Ashley Davidoff MD TheCommonVein.net
Multiple Hepatocellular Adenomas
Current CT shows 2 other homogeneously enhancing small nodules, one posteriorly next to the right hepatic vein and the second a vague region of enhancement anterior to the IVC both confirmed as enhancing lesions on the iodine map from the dual energy sequences.
Pathology confirmed a diagnosis of hepatic adenomatosis.
Ashley Davidoff MD TheCommonVein.net
Iodine Map Multiple Hepatocellular Adenomas
Current dual energy CT confirms 2 other homogeneously enhancing small nodules, one posteriorly next to the right hepatic vein and the second a region of enhancement anterior to the IVC .
Pathology confirmed a diagnosis of hepatic adenomatosis.
Ashley Davidoff MD TheCommonVein.net
Region of Embolized Tumor
Current CT shows a vague area of enhancement in the region of the previously embolized large tumor. Iodine map from the dual energy sequence confirms the presence of residual or recurrent tumor .
Pathology confirmed a diagnosis of hepatic adenomatosis.
Ashley Davidoff MD TheCommonVein.net
Iodine Map in Region of Embolized Tumor
Current dual energy CT confirms a homogeneously enhancing mass in the region of the embolized tumor. This could represent regrowth or residual tumor .
Pathology confirmed a diagnosis of hepatic adenomatosis.
Ashley Davidoff MD TheCommonVein.net