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For those who looked at the movie, here are the findings. First of all, the right side image is a low MI, fundamental gray scale, to monitor where we are imaging, the left side image is the contrast mode. This is a sagital view of left lobe of the liver.

The lesion is occupying the half top of the liver (at the surface). As you can see in the movie, the lesion is very hypervascular in the arterial phase; it is much brighter than other part of the liver, (lesion near surface, liver is beneath). More importantly, you see the vessels in the center of the lesion, which enhance first. This is the spoke wheel patter vessels, with which you can diagnose this lesion as a focal nodular hyperplasia (FNH) by imaging without tissue sampling. The enhancement persists in the portal venous phase (no washout), suggesting benignity of the lesion (not shown in the video).

So, it was a FNH, and thus no intervention was necessary.

Any thoughts?

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Replies to This Discussion

Still FNAC needs to be done after delivery ? what about regenerative nodules ? How safe is contrast in preg ?
No need for FNAC.
-Regenerative nodule: develops in a cirrhotic liver. The patient does not have any underlying liver disease, thus least likely that she develops regenerative nodules.
-NRH (nodular regenerative hyperplasia) is usually diffuse small nodules, which can cause portal hypertension without cirrhosis. Solitary large NRH is very rare, but has been reported. It is usually not hypervascular.
-I am planning to do an MRI after delivery

Definity is a pregnancy category B drug, thus safer than gadolinium for MRI (category C). You don't want to do CT because of radiation. So, I believe contrast ultrasound is the safest imaging study with contrast during pregnancy if necessary.

Thank you for your comment!

Dr MM Nurus shafi said:
Still FNAC needs to be done after delivery ? what about regenerative nodules ? How safe is contrast in preg ?

Respected fellow

If pt is asymptomatic than just request for base line and tuomer marker and follow up till delivery after that ask for CT biphasic and biopsy because contrast enhanced ultrasound cnt help you to determine the nature of the lesion? 


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