A 22yr old lady on the contraceptive pill has a contrast enhanced ultrasound of a hypoechoic liver lesion. The lesion demonstrates prominent centripetal filling in the arterial phase. What is the likely diagnosis?
Focal Nodular Hyperplasia | |
Adenoma | |
HCC | |
Haemangioma | |
Focal steatosis |
This is most likely to be an adenoma. They are the most common focal liver lesion in young women who are on the oral contraceptive pill. They are usually hypoechoic on ultrasound, and their enhancement is variable (but tends towards centripetal or mixed filling pattern). FNH is another possibility, but the enhancement pattern is not characteristic, and the presence of the contraceptive pill makes adenoma more likely. HCC is unlikely in this age-group. Haemangiomas are usually hyperechoic on ultrasound (90%), though do often enhance from the outside inwards. Focal fat would also be hyperechoic, and would not enhance.